Individual
ADRIENNE MCGAHEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
122 CHERRY ST., MARIETTA, GA 30060
(770) 427-7441
(770) 422-2302
Mailing address
122 CHERRY ST., MARIETTA, GA 30060
(770) 427-7441
(770) 422-2302
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
04539
GA
103T00000X
Psychologist
004539
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214383008A
—
GA
Enumeration date
02/27/2007
Last updated
03/08/2010
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