Individual
JUDY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2801 BUFORD HWY NE, SUITE T30, BROOKHAVEN, GA 30329-2149
(678) 856-5031
Mailing address
2801 BUFORD HWY NE, SUITE T30, BROOKHAVEN, GA 30329-2149
(678) 856-5031
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007193
GA
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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