Provider Demographics
NPI:1447886411
Name:WARMKESSEL, MARCIA ELIZABETH (LAPC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELIZABETH
Last Name:WARMKESSEL
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 BRIARWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-2435
Mailing Address - Country:US
Mailing Address - Phone:706-338-6767
Mailing Address - Fax:
Practice Address - Street 1:1622 MARS HILL RD STE A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4893
Practice Address - Country:US
Practice Address - Phone:706-310-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006984101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty