Healthcare Provider Details

I. General information

NPI: 1669653556
Provider Name (Legal Business Name): JAMALYN YATES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 S LEE ST STE 500
BUFORD GA
30518-5785
US

IV. Provider business mailing address

3644 BUTTERCUP CT
BUFORD GA
30519-1983
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-7667
  • Fax:
Mailing address:
  • Phone: 770-339-7667
  • Fax: 770-995-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010629
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: