Provider Demographics
NPI:1588087324
Name:PAIGE HURT, LINDA (LPC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:PAIGE HURT
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 1:110 KLESCO LN
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-2217
Mailing Address - Country:US
Mailing Address - Phone:478-451-3112
Mailing Address - Fax:478-451-0188
Practice Address - Street 1:1776 N JEFFERSON ST NE
Practice Address - Street 2:WIDE RANGE OF RESOURCES
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2229
Practice Address - Country:US
Practice Address - Phone:478-451-3112
Practice Address - Fax:478-451-0188
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007684251B00000X, 101Y00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC007684OtherCOUNSELOR: PRIVATE PRACTICE