Provider Demographics
NPI:1942455274
Name:STALLWORTH, JEMEKA LASHAY (LPC, MSCP, CPCS, NCC)
Entity Type:Individual
Prefix:MS
First Name:JEMEKA
Middle Name:LASHAY
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:LPC, MSCP, CPCS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 KOHL DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7489
Mailing Address - Country:US
Mailing Address - Phone:205-919-6327
Mailing Address - Fax:678-782-5491
Practice Address - Street 1:120 MILLBROOK VILLAGE DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-3605
Practice Address - Country:US
Practice Address - Phone:205-919-6327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health