Provider Demographics
NPI:1972133726
Name:JASPER, ERICA (MS, LAPC, NCC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:JASPER
Suffix:
Gender:F
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 TIMBER SHOALS WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6483
Mailing Address - Country:US
Mailing Address - Phone:770-899-4648
Mailing Address - Fax:
Practice Address - Street 1:561 THORNTON RD
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-1558
Practice Address - Country:US
Practice Address - Phone:770-899-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC00681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional