Provider Demographics
NPI:1497909998
Name:NORTHROP, JESSICA AUSTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:AUSTIN
Last Name:NORTHROP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8910 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4916
Mailing Address - Country:US
Mailing Address - Phone:470-246-3717
Mailing Address - Fax:770-928-5731
Practice Address - Street 1:323 VINE CREEK DR
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5908
Practice Address - Country:US
Practice Address - Phone:470-246-3717
Practice Address - Fax:770-928-5731
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0048651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497909998Medicaid