Provider Demographics
NPI:1508216136
Name:RHOADS, JASON (LPC009045)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RHOADS
Suffix:
Gender:M
Credentials:LPC009045
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 S COBB DR SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6303
Mailing Address - Country:US
Mailing Address - Phone:404-993-7087
Mailing Address - Fax:
Practice Address - Street 1:4015 S COBB DR SE
Practice Address - Street 2:SUITE 1
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6303
Practice Address - Country:US
Practice Address - Phone:404-993-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health