Provider Demographics
NPI:1730469826
Name:MASTROGIOVANNI, JANA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:MASTROGIOVANNI
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3648 PEACHTREE RD NE APT 2M
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1272
Mailing Address - Country:US
Mailing Address - Phone:706-490-2622
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 850
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7156
Practice Address - Country:US
Practice Address - Phone:770-424-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional