Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LPC007307 | GA |
N | 101YP1600X | Pastoral Counselor | LPC007307 | GA |
N | 101YP2500X | Professional Counselor | LPC007307 | GA |
NPI | 1285070102 |
---|---|
Provider Name | Bryan Jones |
First Address | Austell, GA 30106-1559 |
Second Address | Atlanta, GA 30340-3702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2013 |
Last Update Date | 15/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003142232A | (05) | GA |
003143436A | (05) | GA |
003144234A | (05) | GA |