Provider Demographics
NPI:1811245418
Name:PLUNKETT-THOMPSON, CONNIE LYNNE (LPC)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNNE
Last Name:PLUNKETT-THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 BROADSTONE WAY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3516
Mailing Address - Country:US
Mailing Address - Phone:678-524-4448
Mailing Address - Fax:888-459-6039
Practice Address - Street 1:211A MAIN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4261
Practice Address - Country:US
Practice Address - Phone:678-524-4448
Practice Address - Fax:888-459-6039
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional