Provider Demographics
NPI:1811622079
Name:LEETOM, JASNITH JACQUELINE (MASTERS)
Entity Type:Individual
Prefix:MS
First Name:JASNITH
Middle Name:JACQUELINE
Last Name:LEETOM
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:37 CALUMET PKWY
Mailing Address - Street 2:BLDG. J. SUITE 101 & 102
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6734
Mailing Address - Country:US
Mailing Address - Phone:770-683-6946
Mailing Address - Fax:770-683-6949
Practice Address - Street 1:37 CALUMET PKWY
Practice Address - Street 2:BLDG. J. SUITE 101 & 102
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6734
Practice Address - Country:US
Practice Address - Phone:770-683-6946
Practice Address - Fax:770-683-6949
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional