Provider Demographics
NPI:1144654328
Name:PREVETTE, MARCUS ANTHONY (LPC, NCC, CST, CPCS)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANTHONY
Last Name:PREVETTE
Suffix:
Gender:M
Credentials:LPC, NCC, CST, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SENORA PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1582
Mailing Address - Country:US
Mailing Address - Phone:478-370-8476
Mailing Address - Fax:888-798-7392
Practice Address - Street 1:121 SENORA PL
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1582
Practice Address - Country:US
Practice Address - Phone:478-370-8476
Practice Address - Fax:888-798-7392
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003956101YP2500X
GALPC009044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional