1437437662 NPI number — MS. LETITIA WILLETTS BARNES LPC

Table of content: MS. LETITIA WILLETTS BARNES LPC (NPI 1437437662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437437662 NPI number — MS. LETITIA WILLETTS BARNES LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNES
Provider First Name:
LETITIA
Provider Middle Name:
WILLETTS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437437662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
296 S. MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-956-3253
Provider Business Mailing Address Fax Number:
770-442-1542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
296 S. MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-956-3253
Provider Business Practice Location Address Fax Number:
770-442-1542
Provider Enumeration Date:
07/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC006386 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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