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Individual

JESSE LEWALLEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
671 LUMPKIN CAMPGROUND RD S, DAWSONVILLE, GA 30534-0922
(678) 866-8777
Mailing address
5610 LAKEVIEW CT, GAINESVILLE, GA 30506-6517

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC010143
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
LPC010143
GA
Enumeration date
04/09/2018
Last updated
04/09/2018
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