Provider Demographics
NPI:1316300270
Name:HART, DUSTIN (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E JACKSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5175
Mailing Address - Country:US
Mailing Address - Phone:229-234-7337
Mailing Address - Fax:
Practice Address - Street 1:327 E JACKSON ST STE A
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5175
Practice Address - Country:US
Practice Address - Phone:229-516-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14179101YM0800X
GALPC007921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health