Provider Demographics
NPI:1285928747
Name:LERNER, CONSTANCE COOK (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:COOK
Last Name:LERNER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 WILKERSON RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1920
Mailing Address - Country:US
Mailing Address - Phone:404-502-8035
Mailing Address - Fax:
Practice Address - Street 1:55 JONESBORO ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3164
Practice Address - Country:US
Practice Address - Phone:404-502-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional