Individual
JESSICA NOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1690 ROBERTS BLVD NW STE 109, KENNESAW, GA 30144-7829
(404) 640-2605
Mailing address
1836 ROSWELL ST SE APT 8305, SMYRNA, GA 30080-2355
(404) 640-2605
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT001545
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1850
TENNESSEE LICENSE
TN
01
—
MFT001545
LMFT LICENSE
GA
Enumeration date
11/26/2019
Last updated
03/18/2021
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