Provider Demographics
NPI:1770124323
Name:GHOLSON, LULA VARIST (MA CHRISTIAN COUNSEL)
Entity type:Individual
Prefix:
First Name:LULA
Middle Name:VARIST
Last Name:GHOLSON
Suffix:
Gender:F
Credentials:MA CHRISTIAN COUNSEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHRISTIAN COUNSELOR LOU V GHOLSON
Mailing Address - Street 2:4298 CLARION
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288
Mailing Address - Country:US
Mailing Address - Phone:404-783-7962
Mailing Address - Fax:
Practice Address - Street 1:CHRISTIAN COUNSELOR MA LOU GHOLSON
Practice Address - Street 2:549 LAMAR DRIVE
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30294
Practice Address - Country:US
Practice Address - Phone:404-254-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06192021101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA06192021OtherBOARD OF EXAMINERS FOR GEORGIA CHRISTIAN COUNSELORS AND THERAPISTS