Healthcare Provider Details

I. General information

NPI: 1659009090
Provider Name (Legal Business Name): MRS. JAMILAH BILLINGS ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 10/04/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 CAMPBELLTON RD SW
ATLANTA GA
30331-8013
US

IV. Provider business mailing address

50 OAK HARVEST RDG
MIDWAY GA
31320-7159
US

V. Phone/Fax

Practice location:
  • Phone: 404-666-9261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014124
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC007797
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: