Provider Demographics
NPI:1801953500
Name:IMMEL, WILLIAM AMOS (LPC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:AMOS
Last Name:IMMEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SHIPWRECK CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2112
Mailing Address - Country:US
Mailing Address - Phone:912-401-9500
Mailing Address - Fax:404-585-4775
Practice Address - Street 1:3025 BULL ST STE 250
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2016
Practice Address - Country:US
Practice Address - Phone:912-401-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002725101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional