Provider Demographics
NPI:1104525047
Name:AUSTIN, JAKEISHA JANA (LPC)
Entity type:Individual
Prefix:
First Name:JAKEISHA
Middle Name:JANA
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JAKEISHA AUSTIN LPC
Mailing Address - Street 1:450 PIEDMONT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3455
Mailing Address - Country:US
Mailing Address - Phone:404-375-5295
Mailing Address - Fax:
Practice Address - Street 1:450 PIEDMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3455
Practice Address - Country:US
Practice Address - Phone:404-375-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012651101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor