Provider Demographics
NPI:1629323878
Name:CAMP, JESSICA M (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:CAMP
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 1:4630 JONES BRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 PIRKLE FERRY RD
Practice Address - Street 2:STE #104
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2529
Practice Address - Country:US
Practice Address - Phone:678-983-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional