| Doctor Name: | MR. MARK PIERSON PENTECOST |
| NPI Number: | 1073826830 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | GALPC003156 |
| Business Practice Address: | 292 N Broad St Winder, GA - 306802149 |
| Business Phone Number: | 7065497755 |
| Business Fax Number: | |
| Mailing Address: | 1435 Oglethorp Ave, ATHENS |
| State: | GA |
| Postal Code: | 306062135 |
| Phone Number: | 7065497755 |
| Fax Number: | 7065490428 |
| NPI Enumeration Date: | 07/22/2010 |
| NPI Last Update Date: | 07/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | GALPC003156 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |