Provider Demographics
NPI:1457709735
Name:PENNINGTON, JOSEPH SCOTT (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SCOTT
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:SCOTT
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2308 TREE ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064
Mailing Address - Country:US
Mailing Address - Phone:678-642-1111
Mailing Address - Fax:
Practice Address - Street 1:2440 SANDY PLAINS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7217
Practice Address - Country:US
Practice Address - Phone:678-642-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional