Provider Demographics
NPI:1104056456
Name:GOODELL, JANNAH S (LCSW, LPC, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:JANNAH
Middle Name:S
Last Name:GOODELL
Suffix:
Gender:F
Credentials:LCSW, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SUMMIT POINTE WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4063
Mailing Address - Country:US
Mailing Address - Phone:678-733-2728
Mailing Address - Fax:
Practice Address - Street 1:1010 SUMMIT POINTE WAY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4063
Practice Address - Country:US
Practice Address - Phone:678-733-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005371101YP2500X
GACSW0041221041C0700X
90-062221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist