Provider Demographics
NPI:1275058711
Name:PEREZ, JESSICA (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 ATLANTA RD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6526
Mailing Address - Country:US
Mailing Address - Phone:708-585-3777
Mailing Address - Fax:770-874-3310
Practice Address - Street 1:4125 ATLANTA RD SE STE 120
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6526
Practice Address - Country:US
Practice Address - Phone:770-858-5377
Practice Address - Fax:404-874-3310
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0079341041C0700X
GACSW0073111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical