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General NPI Number Information
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NPI Number | 1346415569
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Entity Type | Individual
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Provider Name | JIVANDA VERMELL GREGG LPC
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Gender | Female
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 2700 CUMBERLAND PKWY SE SUITE 120
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City | ATLANTA
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State | GA
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Zip | 30339-3321
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Country | US
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Telephone | 770-431-0299
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Fax | 186-641-6176
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Provider Business Mailing Address
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Address Line | 2854 AXTON CV
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-2911
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Country | US
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Telephone | 770-789-6403
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Fax | 678-945-0177
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 005239
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License Number State | GA
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