Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC003576 | GA |
NPI | 1003236183 |
---|---|
Provider Name | Courtney Jones-Hall |
First Address | Tucker, GA 30084-5888 |
Second Address | Tucker, GA 30084-5888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 16/04/2014 |