Provider Demographics
NPI:1396857124
Name:GLASS, JANA (LPC)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:GLASS
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 1:244 13TH ST NE
Mailing Address - Street 2:#219
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-7646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:544 MEDLOCK RD
Practice Address - Street 2:SUITE 112
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1515
Practice Address - Country:US
Practice Address - Phone:404-307-4917
Practice Address - Fax:404-892-8334
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC #003501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health