Provider Demographics
NPI:1548455595
Name:LANDRY, KAREN ELIZABETH (LPC)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELIZABETH
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1659 HIGHWAY 20 W # 392
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7311
Mailing Address - Country:US
Mailing Address - Phone:678-907-8565
Mailing Address - Fax:678-228-1961
Practice Address - Street 1:314 GLADSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7311
Practice Address - Country:US
Practice Address - Phone:678-907-8565
Practice Address - Fax:678-228-1961
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1548455595OtherNPI