Provider Demographics
NPI:1467766360
Name:SCHMOLL, JESSICA LAIBSON (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAIBSON
Last Name:SCHMOLL
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 1:122 W TRINITY PL APT 3305
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3593
Mailing Address - Country:US
Mailing Address - Phone:404-449-6199
Mailing Address - Fax:
Practice Address - Street 1:1455 LINCOLN PKWY E STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-2209
Practice Address - Country:US
Practice Address - Phone:404-449-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005396101YP2500X
GA005396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health