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General NPI Number Information
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NPI Number | 1184408312
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Entity Type | Individual
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Provider Name | JEANINE CARSON
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Gender | Female
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 311 WHITE INGRAM PKWY
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City | DALLAS
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State | GA
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Zip | 30132-0969
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Country | US
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Telephone | 678-363-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 RIDGE WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3734
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 01787
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | GA
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