Provider Demographics
NPI:1316246044
Name:OVERDORFF, JEFFREY ALLAN (LPC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:OVERDORFF
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1444 WILTSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-1364
Mailing Address - Country:US
Mailing Address - Phone:404-769-3084
Mailing Address - Fax:678-601-6292
Practice Address - Street 1:848 HIRAM ACWORTH HWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2286
Practice Address - Country:US
Practice Address - Phone:404-769-3084
Practice Address - Fax:678-601-6292
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006329101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107804BMedicaid