Healthcare Provider Details

I. General information

NPI: 1790150423
Provider Name (Legal Business Name): JAMIE PERRELLA FLYNN-PRESSLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE PERRYMAN

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CRIS ANN ST.
LEESBURG GA
31763
US

IV. Provider business mailing address

112 CRIS ANN ST.
LEESBURG GA
31763
US

V. Phone/Fax

Practice location:
  • Phone: 229-854-5817
  • Fax:
Mailing address:
  • Phone: 229-854-5817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008579
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: