Healthcare Provider Details

I. General information

NPI: 1437864246
Provider Name (Legal Business Name): JESSICA TIWARI LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MERCER UNIVERSITY DR STE 110
ATLANTA GA
30341-4135
US

IV. Provider business mailing address

3060 MERCER UNIVERSITY DR STE 110
ATLANTA GA
30341-4135
US

V. Phone/Fax

Practice location:
  • Phone: 678-480-6780
  • Fax:
Mailing address:
  • Phone: 678-480-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014619
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: