Provider Demographics
NPI:1619933645
Name:CROSS-LEE, JAMIE GYNETTE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:GYNETTE
Last Name:CROSS-LEE
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 1:5400 LAWRENCEVILLE HWY NW STE E3
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5956
Mailing Address - Country:US
Mailing Address - Phone:404-503-0701
Mailing Address - Fax:404-537-1947
Practice Address - Street 1:5400 LAWRENCEVILLE HWY NW STE E3
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:404-503-0701
Practice Address - Fax:404-537-1947
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA501854029AMedicaid