Provider Demographics
NPI:1942657580
Name:DUNAGAN, JACKIE (LAMFT)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:DUNAGAN
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 SUWANEE DAM RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8701
Mailing Address - Country:US
Mailing Address - Phone:404-861-0992
Mailing Address - Fax:
Practice Address - Street 1:4680 WILLOWBROOK CT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-6960
Practice Address - Country:US
Practice Address - Phone:404-861-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000374106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist