Provider Demographics
NPI:1104350735
Name:HARRISON, JADA (LPC)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ATHENS ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-1401
Mailing Address - Country:US
Mailing Address - Phone:770-286-0120
Mailing Address - Fax:
Practice Address - Street 1:83 ATHENS ST
Practice Address - Street 2:SUITE 3
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1401
Practice Address - Country:US
Practice Address - Phone:770-286-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional