Individual
MRS. JESSICA DIANE ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
306 CORDER RD, WARNER ROBINS, GA 31088-3647
(478) 971-4684
Mailing address
121 CHADWYCK LN, BONAIRE, GA 31005-3151
(478) 971-4684
(478) 971-4685
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC006368
GA
Other
Enumeration date
02/04/2010
Last updated
09/14/2016
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