Healthcare Provider Details

I. General information

NPI: 1790544054
Provider Name (Legal Business Name): JODIE SCHNEEBERG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 PARKWAY NORTH BLVD STE A
CUMMING GA
30040-1431
US

IV. Provider business mailing address

5965 PARKWAY NORTH BLVD STE A
CUMMING GA
30040-1431
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8100
  • Fax:
Mailing address:
  • Phone: 770-389-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4161
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014211
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: