Individual
JACKIE HORNBECK WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
317 W HILL ST STE 204A, DECATUR, GA 30030-4367
(404) 518-3524
Mailing address
315 ADAMS ST, DECATUR, GA 30030-5205
(404) 518-3524
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC010696
GA
101YM0800X
Mental Health Counselor
Primary
LPC010696
GA
Other
Enumeration date
01/06/2021
Last updated
01/06/2021
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