Individual
MS. LAVONNA WINFREDA OWENS-JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, CCM
Contact information
Practice address
1192 ROCKBRIDGE RD STE A, STONE MOUNTAIN, GA 30087-2923
(770) 925-2010
Mailing address
3040 LAKESIDE CIR, COVINGTON, GA 30016-8892
(678) 478-5860
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC008416
GA
Other
Enumeration date
04/21/2022
Last updated
04/21/2022
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