Provider Demographics
NPI:1952565798
Name:PRESTIGIACOMO, MONICA MEGAN (LPC GA 3057)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MEGAN
Last Name:PRESTIGIACOMO
Suffix:
Gender:F
Credentials:LPC GA 3057
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12285 BROADWELL RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4016
Mailing Address - Country:US
Mailing Address - Phone:678-366-9388
Mailing Address - Fax:678-366-6156
Practice Address - Street 1:12285 BROADWELL RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4016
Practice Address - Country:US
Practice Address - Phone:678-366-9388
Practice Address - Fax:678-366-6156
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health