Provider Demographics
NPI:1396820387
Name:CARLTON, JODI LEIGH (MED, LPC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LEIGH
Last Name:CARLTON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HIGHLAND POINTE CIR E
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-9417
Mailing Address - Country:US
Mailing Address - Phone:770-335-3639
Mailing Address - Fax:
Practice Address - Street 1:101 COLONY PARK DR
Practice Address - Street 2:SUITE 200A
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2751
Practice Address - Country:US
Practice Address - Phone:678-679-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003878101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA63703OtherNATIONAL CERTIFICATION