Provider Demographics
NPI:1194057406
Name:STOKES, BERNICE FOREMAN (COUNSELOR)
Entity type:Individual
Prefix:DR
First Name:BERNICE
Middle Name:FOREMAN
Last Name:STOKES
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WELLS DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-6108
Mailing Address - Country:US
Mailing Address - Phone:912-537-1988
Mailing Address - Fax:912-526-6783
Practice Address - Street 1:196 W LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-1412
Practice Address - Country:US
Practice Address - Phone:912-526-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LPC005862OtherLICENSE PROFESSIONAL COUNSELOR