Provider Demographics
NPI:1457563710
Name:HAMBY, DEANNA J (MA, LPC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:J
Last Name:HAMBY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 JT WALLACE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-0824
Mailing Address - Country:US
Mailing Address - Phone:404-317-9991
Mailing Address - Fax:
Practice Address - Street 1:3192 SPRING ST NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2269
Practice Address - Country:US
Practice Address - Phone:404-317-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC004744OtherLICENSED PROF. COUNSELOR
GA172615OtherPSY. REHAB. (CPRP)