Provider Demographics
NPI:1366880601
Name:ROUNTREE, MARLA (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:
Last Name:ROUNTREE
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 1:3310 BEMISS RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7014
Mailing Address - Country:US
Mailing Address - Phone:222-232-4833
Mailing Address - Fax:877-343-0538
Practice Address - Street 1:3310 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7014
Practice Address - Country:US
Practice Address - Phone:229-586-6082
Practice Address - Fax:229-922-9374
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1548705031OtherBLUE CROSS BLUE SHIELD/ANTHEM