Provider Demographics
NPI:1447729546
Name:ESLAVA, MEGAN BENTLEY (LPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BENTLEY
Last Name:ESLAVA
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 1:915C INTERSTATE RIDGE DR # C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7051
Mailing Address - Country:US
Mailing Address - Phone:706-466-5708
Mailing Address - Fax:
Practice Address - Street 1:915C INTERSTATE RIDGE DR # C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7051
Practice Address - Country:US
Practice Address - Phone:678-207-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional