Individual
MRS. DEWANDA B. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CPCS, EAU-C
Contact information
Practice address
4319 COVINGTON HWY STE 110, DECATUR, GA 30035-1206
(404) 286-0054
(404) 286-0064
Mailing address
PO BOX 1501, LITHONIA, GA 30058-1007
(404) 286-0054
(404) 286-0064
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC002390
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC002390
PROFESSIONAL COUNSELOR
GA
Enumeration date
02/01/2007
Last updated
06/23/2021
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