Provider Demographics
NPI:1639653298
Name:HORTMAN, JANE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HORTMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 6TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3050
Mailing Address - Country:US
Mailing Address - Phone:706-250-1634
Mailing Address - Fax:
Practice Address - Street 1:104 W 6TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3050
Practice Address - Country:US
Practice Address - Phone:706-250-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006494101YM0800X
GALPC012297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health