Provider Demographics
NPI:1063134807
Name:OAKLEY, MARK (LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:OAKLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ALEC DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:GA
Mailing Address - Zip Code:30426-4371
Mailing Address - Country:US
Mailing Address - Phone:630-728-6514
Mailing Address - Fax:
Practice Address - Street 1:127 ALEC DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:GA
Practice Address - Zip Code:30426-4371
Practice Address - Country:US
Practice Address - Phone:630-728-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013128101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor