Individual
EMILY NANETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NCC, CSOTS
Contact information
Practice address
200 N LEWIS ST, LAGRANGE, GA 30240-2738
(706) 887-5787
(706) 780-5402
Mailing address
200 N LEWIS ST, LAGRANGE, GA 30240-2738
(706) 887-5787
(706) 780-5402
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC006931
GA
101YP2500X
Professional Counselor
Primary
LPC006931
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003215089A
—
GA
Enumeration date
01/20/2012
Last updated
03/04/2020
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