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General NPI Number Information
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NPI Number | 1497909998
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Entity Type | Individual
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Provider Name | JESSICA AUSTIN NORTHROP LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 323 VINE CREEK DR
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City | ACWORTH
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State | GA
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Zip | 30101-5908
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Country | US
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Telephone | 470-246-3717
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Fax | 770-928-5731
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Provider Business Mailing Address
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Address Line | 8910 MAIN ST
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City | WOODSTOCK
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State | GA
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Zip | 30188-4916
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Country | US
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Telephone | 470-246-3717
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Fax | 770-928-5731
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004865
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License Number State | GA
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