Provider Demographics
NPI:1366084576
Name:DEMINE, BETTY KATHLEEN (LPC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:KATHLEEN
Last Name:DEMINE
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 1:756 WOODBURY HWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30222-1514
Mailing Address - Country:US
Mailing Address - Phone:706-672-1118
Mailing Address - Fax:706-672-1918
Practice Address - Street 1:420 THOMASTON ST
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:GA
Practice Address - Zip Code:30295-3387
Practice Address - Country:US
Practice Address - Phone:404-960-1282
Practice Address - Fax:855-817-2428
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007579101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health