Individual
JON PATRICK COSTALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
310 PAPER TRAIL WAY STE 106, CANTON, GA 30115-5204
(678) 880-4645
Mailing address
7339 REINHARDT COLLEGE PKWY, WALESKA, GA 30183-2901
(404) 446-7678
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC009867
GA
Other
Enumeration date
02/07/2019
Last updated
02/07/2019
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