Provider Demographics
NPI:1629301882
Name:COMBS, JANAE AYODELE
Entity Type:Individual
Prefix:MRS
First Name:JANAE
Middle Name:AYODELE
Last Name:COMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090A HIGHWAY 317 # 276
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2623
Mailing Address - Country:US
Mailing Address - Phone:678-431-4861
Mailing Address - Fax:678-407-4444
Practice Address - Street 1:265 W PIKE ST STE 4
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4896
Practice Address - Country:US
Practice Address - Phone:678-431-4861
Practice Address - Fax:678-407-4444
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional