Healthcare Provider Details

I. General information

NPI: 1487524872
Provider Name (Legal Business Name): JANNA D LECROY LPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4434 COLUMBIA RD STE 205
AUGUSTA GA
30907-4281
US

IV. Provider business mailing address

237 DEERFIELD LN
AUGUSTA GA
30907-2419
US

V. Phone/Fax

Practice location:
  • Phone: 706-910-0538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: