Provider Demographics
NPI:1023264801
Name:BEALL, LAURIE G (LPC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:G
Last Name:BEALL
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 1:1501 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6496
Mailing Address - Country:US
Mailing Address - Phone:770-677-9300
Mailing Address - Fax:770-953-0807
Practice Address - Street 1:1501 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6496
Practice Address - Country:US
Practice Address - Phone:770-677-9300
Practice Address - Fax:770-953-0807
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC004662OtherLPC