Provider Demographics
NPI:1245777952
Name:WALSH, COLLEEN ELIZABETH (LPC)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480H S COBB DR SE # 258
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6958
Mailing Address - Country:US
Mailing Address - Phone:404-480-2038
Mailing Address - Fax:
Practice Address - Street 1:707 WHITLOCK AVE SW
Practice Address - Street 2:SUITE C28
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4655
Practice Address - Country:US
Practice Address - Phone:404-480-2038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GALPC009095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health