Healthcare Provider Details

I. General information

NPI: 1912398868
Provider Name (Legal Business Name): THE NORTHROP CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W MEMORIAL DR
DALLAS GA
30132-4122
US

IV. Provider business mailing address

702 W MEMORIAL DR
DALLAS GA
30132-4122
US

V. Phone/Fax

Practice location:
  • Phone: 678-332-7955
  • Fax: 678-719-7540
Mailing address:
  • Phone: 678-332-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA AUSTIN NORTHROP
Title or Position: OWNER
Credential: LCSW
Phone: 678-332-7955