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General NPI Number Information
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NPI Number | 1154125748
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Entity Type | Individual
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Provider Name | JESSICA FOSSE CRC
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Gender | Female
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 1730 MOUNT VERNON RD STE G
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City | ATLANTA
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State | GA
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Zip | 30338-4245
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Country | US
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Telephone | 770-815-6853
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Fax |
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Provider Business Mailing Address
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Address Line | 1160 JOHNSON FY RD NE UNIT 1409
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City | SANDY SPRINGS
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State | GA
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Zip | 30342-2338
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Country | US
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Telephone | 423-619-7794
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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