Provider Demographics
NPI:1194269704
Name:FLEET, GENIE NALL (LPC)
Entity type:Individual
Prefix:
First Name:GENIE
Middle Name:NALL
Last Name:FLEET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1346
Mailing Address - Country:US
Mailing Address - Phone:912-268-4750
Mailing Address - Fax:888-837-0039
Practice Address - Street 1:300 OAK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4738
Practice Address - Country:US
Practice Address - Phone:912-268-4750
Practice Address - Fax:888-837-0039
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional