Provider Demographics
NPI:1255141164
Name:OLDHAM, ZOAUNTRIST LAVETTE (LPC)
Entity type:Individual
Prefix:DR
First Name:ZOAUNTRIST
Middle Name:LAVETTE
Last Name:OLDHAM
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:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-7126
Mailing Address - Country:US
Mailing Address - Phone:678-362-0320
Mailing Address - Fax:
Practice Address - Street 1:149 BURKE ST STE B
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3440
Practice Address - Country:US
Practice Address - Phone:678-362-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional