Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 006449 | GA |
NPI | 1003428764 |
---|---|
Provider Name | Jessica Ringsmuth |
First Address | Tucker, GA 30084-2331 |
Second Address | Tucker, GA 30084-4492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2020 |
Last Update Date | 23/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LPC006449 | LICENCED PROFESSIONAL COUNSELOR (01) | GA |