Provider Demographics
NPI:1740607142
Name:CABRERA, JESSICA KRISTIN (MS, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KRISTIN
Last Name:CABRERA
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:CABRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, NCC
Mailing Address - Street 1:8303 OFFICE PARK DR
Mailing Address - Street 2:STE.B
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6935
Mailing Address - Country:US
Mailing Address - Phone:678-838-8333
Mailing Address - Fax:678-838-8444
Practice Address - Street 1:8303 OFFICE PARK DR
Practice Address - Street 2:STE.B
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6935
Practice Address - Country:US
Practice Address - Phone:678-838-8333
Practice Address - Fax:678-838-8444
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool