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:
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Health care specialties

SpecialtyCodeLicense #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 5 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 1184761561 NPPES
Georgia Other LPC002390 PROFESSIONAL COUNSELOR

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