Provider Demographics
NPI:1831792290
Name:ATAGA, JASMAINE (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:JASMAINE
Middle Name:
Last Name:ATAGA
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 BLUE HERON PASS
Mailing Address - Street 2:
Mailing Address - City:POWDER SPGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2395
Mailing Address - Country:US
Mailing Address - Phone:470-985-3580
Mailing Address - Fax:
Practice Address - Street 1:25 SW 5TH TER APT UNIT4422
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6219
Practice Address - Country:US
Practice Address - Phone:470-985-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional