Provider Demographics
NPI:1053894352
Name:PRICE, LAURA MEGAN (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MEGAN
Last Name:PRICE
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 1:3370 VINEVILLE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2331
Mailing Address - Country:US
Mailing Address - Phone:478-254-3751
Mailing Address - Fax:478-254-3752
Practice Address - Street 1:3370 VINEVILLE AVE STE 110
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2331
Practice Address - Country:US
Practice Address - Phone:478-254-3751
Practice Address - Fax:478-254-3752
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional