Healthcare Provider Details

I. General information

NPI: 1043137102
Provider Name (Legal Business Name): JESSICA LUNDY LPC, RPT, ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 REGATTA GRV
ALPHARETTA GA
30004-0609
US

IV. Provider business mailing address

3302 REGATTA GRV
ALPHARETTA GA
30004-0609
US

V. Phone/Fax

Practice location:
  • Phone: 404-620-0696
  • Fax:
Mailing address:
  • Phone: 404-580-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009644
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: