Provider Demographics
NPI:1386047694
Name:PAXTON, AMBER (LPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PAXTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 GEORGIA HIGHWAY 212 SW
Mailing Address - Street 2:A-STE #240
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3363
Mailing Address - Country:US
Mailing Address - Phone:770-689-6039
Mailing Address - Fax:
Practice Address - Street 1:2890 GEORGIA HIGHWAY 212 SW
Practice Address - Street 2:A-STE #240
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3363
Practice Address - Country:US
Practice Address - Phone:770-689-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional