Individual
CARLA JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4151 MEMORIAL DR STE 209C, DECATUR, GA 30032-1597
(404) 508-0078
(404) 508-0071
Mailing address
4151 MEMORIAL DR STE 209C, DECATUR, GA 30032-1597
(404) 508-0078
(404) 508-0071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CSW006674
GA
Other
Enumeration date
11/05/2020
Last updated
11/05/2020
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