Provider Demographics
NPI:1679278659
Name:REDDY, GISELLE (LPC)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:REDDY
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 1:17 LATIMER ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-6259
Mailing Address - Country:US
Mailing Address - Phone:912-888-8009
Mailing Address - Fax:443-703-7810
Practice Address - Street 1:17 LATIMER ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6259
Practice Address - Country:US
Practice Address - Phone:912-888-8009
Practice Address - Fax:443-703-7810
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012997101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional