Provider Demographics
NPI:1831577097
Name:MIDUSKI, SAREENA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:SAREENA
Middle Name:LYNN
Last Name:MIDUSKI
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 1:1782 INLET COVE TER
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6660
Mailing Address - Country:US
Mailing Address - Phone:678-908-2603
Mailing Address - Fax:
Practice Address - Street 1:160 CLAIREMONT AVE STE 445
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2574
Practice Address - Country:US
Practice Address - Phone:770-389-8100
Practice Address - Fax:404-500-4283
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health