Provider Demographics
NPI:1093043432
Name:JAMISON, LEANNE (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 EMERALD FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5851
Mailing Address - Country:US
Mailing Address - Phone:404-510-4691
Mailing Address - Fax:
Practice Address - Street 1:55 JONESBORO ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3164
Practice Address - Country:US
Practice Address - Phone:404-510-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional