Provider Demographics
NPI:1225809817
Name:JLA COUNSELING PC
Entity Type:Organization
Organization Name:JLA COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:ADRIATICO
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-201-9063
Mailing Address - Street 1:PO BOX 6484
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-6484
Mailing Address - Country:US
Mailing Address - Phone:704-201-9063
Mailing Address - Fax:
Practice Address - Street 1:119 FUCHIA LN
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4287
Practice Address - Country:US
Practice Address - Phone:704-201-9063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty