Provider Demographics
NPI:1467521336
Name:MCCLEOD, JAMISE R (LPC)
Entity Type:Individual
Prefix:
First Name:JAMISE
Middle Name:R
Last Name:MCCLEOD
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 1:3135 SUNLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2787
Mailing Address - Country:US
Mailing Address - Phone:770-333-0139
Mailing Address - Fax:770-944-0632
Practice Address - Street 1:3135 SUNLIGHT DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2787
Practice Address - Country:US
Practice Address - Phone:770-333-0139
Practice Address - Fax:770-944-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional