Provider Demographics
NPI:1497011332
Name:MASSINGILLE, NANCY JO (LMFT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JO
Last Name:MASSINGILLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CRESTVIEW CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6422
Mailing Address - Country:US
Mailing Address - Phone:478-335-6065
Mailing Address - Fax:478-953-0214
Practice Address - Street 1:116 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2891
Practice Address - Country:US
Practice Address - Phone:478-464-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist