Individual
JAQUITA SHORTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1705 PENNSLYVANIA AVE, MCDONOUGH, GA 30252
(678) 853-5849
Mailing address
9109 BOSTON HARBOR WAY, MCDONOUGH, GA 30252-8951
(770) 378-4917
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC010510
GA
106H00000X
Marriage & Family Therapist
MFT001529
GA
Other
Enumeration date
12/22/2015
Last updated
11/08/2020
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