Individual
JACQUELINE LATRICIA SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NCC
Contact information
Practice address
80 JOSEPH E LOWERY BLVD NW, ATLANTA, GA 30314-3421
(404) 226-7553
Mailing address
PO BOX 5810, ATLANTA, GA 31107-0810
(404) 226-7553
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC005620
GA
Other
Enumeration date
07/18/2010
Last updated
01/26/2023
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