Provider Demographics
NPI:1598039109
Name:YEARTA, JESSIE (LPC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:YEARTA
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 1:1845 WALDREP CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-4927
Mailing Address - Country:US
Mailing Address - Phone:770-432-6388
Mailing Address - Fax:
Practice Address - Street 1:1845 WALDREP CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-4927
Practice Address - Country:US
Practice Address - Phone:770-432-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional