Provider Demographics
NPI:1346671583
Name:FROST, JESSICA J (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:FROST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-2612
Mailing Address - Country:US
Mailing Address - Phone:912-282-0992
Mailing Address - Fax:912-285-8817
Practice Address - Street 1:204 S CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-2612
Practice Address - Country:US
Practice Address - Phone:912-282-0992
Practice Address - Fax:912-285-8817
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional