Provider Demographics
NPI:1326714999
Name:SAMBOU, LANEE' (LPC)
Entity type:Individual
Prefix:
First Name:LANEE'
Middle Name:
Last Name:SAMBOU
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 RIVER MILL LN
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1360
Mailing Address - Country:US
Mailing Address - Phone:404-580-7407
Mailing Address - Fax:
Practice Address - Street 1:2795 W MAIN ST STE 19A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3072
Practice Address - Country:US
Practice Address - Phone:678-408-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GALPC015582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician