Healthcare Provider Details

I. General information

NPI: 1104703644
Provider Name (Legal Business Name): JAYLIN JENE ROSS LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CHURCHILL PL
WARNER ROBINS GA
31088-3058
US

IV. Provider business mailing address

114 CHURCHILL PL
WARNER ROBINS GA
31088-3058
US

V. Phone/Fax

Practice location:
  • Phone: 478-227-3001
  • Fax:
Mailing address:
  • Phone: 478-227-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: