Provider Demographics
NPI:1306218409
Name:POOLE, CONNIE LEIGH (MA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:LEIGH
Last Name:POOLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:LEIGH
Other - Last Name:FUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3015
Mailing Address - Country:US
Mailing Address - Phone:229-931-2504
Mailing Address - Fax:229-931-2474
Practice Address - Street 1:415 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3015
Practice Address - Country:US
Practice Address - Phone:229-931-2504
Practice Address - Fax:229-931-2474
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor