Healthcare Provider Details

I. General information

NPI: 1659520161
Provider Name (Legal Business Name): JASON PATTERSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 12TH ST
COLUMBUS GA
31901-2522
US

IV. Provider business mailing address

7217 AFFIRM LN
COLUMBUS GA
31909-1836
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-7776
  • Fax: 706-494-7076
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009418
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: