Provider Demographics
NPI:1447795919
Name:JESSICA CAMP LPC, PC
Entity Type:Organization
Organization Name:JESSICA CAMP LPC, PC
Other - Org Name:BEACON COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-983-8993
Mailing Address - Street 1:327 DAHLONEGA ST
Mailing Address - Street 2:902B
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2480
Mailing Address - Country:US
Mailing Address - Phone:678-983-8993
Mailing Address - Fax:800-690-3302
Practice Address - Street 1:327 DAHLONEGA ST
Practice Address - Street 2:902B
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2480
Practice Address - Country:US
Practice Address - Phone:678-983-8993
Practice Address - Fax:800-690-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003153555AMedicaid