Provider Demographics
NPI:1154125748
Name:FOSSE, JESSICA (CRC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FOSSE
Suffix:
Gender:
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 JOHNSON FY RD NE UNIT 1409
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2338
Mailing Address - Country:US
Mailing Address - Phone:423-619-7794
Mailing Address - Fax:
Practice Address - Street 1:1730 MOUNT VERNON RD STE G
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4245
Practice Address - Country:US
Practice Address - Phone:770-815-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor