Provider Demographics
NPI:1265147615
Name:SNELLGROVE, LEANN PHILLIPS (LPC)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:PHILLIPS
Last Name:SNELLGROVE
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 95
Mailing Address - Street 2:
Mailing Address - City:NUNEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30448-0095
Mailing Address - Country:US
Mailing Address - Phone:478-299-6281
Mailing Address - Fax:
Practice Address - Street 1:48 GAY RD
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-5201
Practice Address - Country:US
Practice Address - Phone:478-299-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional