Provider Demographics
NPI:1871614636
Name:HORNE, MARYANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:
Last Name:HORNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 FORT SHAWNEE TRCE
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7006
Mailing Address - Country:US
Mailing Address - Phone:770-932-9327
Mailing Address - Fax:
Practice Address - Street 1:1701 FORT SHAWNEE TRCE
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7006
Practice Address - Country:US
Practice Address - Phone:770-932-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004722101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor