Jackson, Dewanda B.
Jackson, Dewanda B. is an individual health care provider with primary practice located at 4319 Covington Hwy Ste 110 , Decatur GA 30035-1206. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Jackson, Dewanda B. can be contacted via phone (404) 286-0054.Contact Information
Primary practice address
4319 Covington Hwy Ste 110
Decatur GA 30035-1206
Phone: (404) 286-0054
Fax: (404) 286-0064
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Professional | 101YP2500X | LPC002390 | Georgia |
Profile Details
NPI number | 1184761561 |
---|---|
LBN Legal business name | Jackson, Dewanda B. |
Credentials | LPC, CPCS, EAU-C |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Feb 1st, 2007 |
Last updated | Jun 23rd, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1184761561 | NPPES |
Georgia | Other | LPC002390 | PROFESSIONAL COUNSELOR |
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