Organization
JACOB'S LADDER NEURODEVELOPMENTAL LEARNING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY O'DELL M.ED, LPC, LAT, CNC (FOUNDER/DIRECTOR)
(770) 998-1017
Entity
Organization
Contact information
Practice address
407 HARDSCRABBLE RD, ROSWELL, GA 30075-1417
(770) 998-1017
(770) 998-3258
Mailing address
407 HARDSCRABBLE RD, ROSWELL, GA 30075-1417
(770) 998-1017
(770) 998-3258
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MSW006914
GA
101YP2500X
Professional Counselor
Primary
LPC004163
GA
103TS0200X
School Psychologist
09634048
GA
1041C0700X
Clinical Social Worker
MSW006790
GA
2251P0200X
Pediatric Physical Therapist
PT002001
GA
2251P0200X
Pediatric Physical Therapist
PT010499
GA
225XP0200X
Pediatric Occupational Therapist
1059
GA
225XP0200X
Pediatric Occupational Therapist
OT005584
GA
235Z00000X
Speech-Language Pathologist
SLP007882
GA
Other
Enumeration date
04/05/2010
Last updated
11/23/2015
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