Provider Demographics
NPI:1396944112
Name:JOSEPHS, NADINE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:JOSEPHS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:JOSEPHS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 3592
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-1979
Mailing Address - Country:US
Mailing Address - Phone:770-873-8569
Mailing Address - Fax:770-873-8569
Practice Address - Street 1:3690 FRANKIE WADE LN
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5311
Practice Address - Country:US
Practice Address - Phone:770-873-8569
Practice Address - Fax:770-972-5156
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 005786101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional