Provider Demographics
NPI:1679880181
Name:BALES, REBA ELLEN (LPC, CPCS)
Entity type:Individual
Prefix:MS
First Name:REBA
Middle Name:ELLEN
Last Name:BALES
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 5TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3128
Mailing Address - Country:US
Mailing Address - Phone:706-509-0130
Mailing Address - Fax:706-237-6503
Practice Address - Street 1:509 BENJAMIN WAY
Practice Address - Street 2:SUITE 504
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4626
Practice Address - Country:US
Practice Address - Phone:706-509-0130
Practice Address - Fax:706-237-6503
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001530101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health