Jackson, Emily Nanette

Jackson, Emily Nanette is an sole proprietor health care provider with primary practice located at 200 N Lewis St , Lagrange GA 30240-2738. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Jackson, Emily Nanette can be contacted via phone (706) 887-5787.

Contact Information

Primary practice address
200 N Lewis St Lagrange GA 30240-2738
Phone: (706) 887-5787
Fax: (706) 780-5402
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X LPC006931 Georgia
Behavioral Health & Social Service Providers / Professional 101YP2500X LPC006931 Georgia

Profile Details

NPI number 1386915494
LBN Legal business name Jackson, Emily Nanette
Credentials LPC, NCC, CSOTS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 20th, 2012
Last updated Mar 4th, 2020 - about 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386915494 NPPES
Georgia MEDICAID 003215089A

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