Provider Demographics
NPI:1063731560
Name:MCKIE-VOERSTE, TRAVIS (LPC, NCC, ACS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:MCKIE-VOERSTE
Suffix:
Gender:M
Credentials:LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-4511
Mailing Address - Country:US
Mailing Address - Phone:870-219-4086
Mailing Address - Fax:
Practice Address - Street 1:96 TERRACE CT
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705
Practice Address - Country:US
Practice Address - Phone:870-219-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
GALPC0006978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor