Provider Demographics
NPI:1649550500
Name:MAY, LARA M
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:M
Last Name:MAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LIBERTY LN SW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701
Mailing Address - Country:US
Mailing Address - Phone:772-360-9242
Mailing Address - Fax:
Practice Address - Street 1:501 CARTECAY DR
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-5423
Practice Address - Country:US
Practice Address - Phone:772-360-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-17-25492103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty