Provider Demographics
NPI:1093951410
Name:FRANCIS, JESSICA LYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYN
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LYN
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:110 EVANS MILL DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1622
Mailing Address - Country:US
Mailing Address - Phone:770-445-6358
Mailing Address - Fax:770-445-7262
Practice Address - Street 1:110 EVANS MILL DR
Practice Address - Street 2:SUITE 305
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1622
Practice Address - Country:US
Practice Address - Phone:770-445-6358
Practice Address - Fax:770-445-7262
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0048101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12411250OtherCAQH
202I804084Medicare PIN