Individual
JERRUROD PAUL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2611 REDDING RD NE, BROOKHAVEN, GA 30319-2905
(770) 882-7091
Mailing address
2611 REDDING RD NE, BROOKHAVEN, GA 30319-2905
(770) 882-7091
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC014551
GA
106S00000X
Behavior Technician
19-85867
GA
106S00000X
Behavior Technician
RBT-19-85867
GA
Other
Enumeration date
05/13/2019
Last updated
07/23/2024
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