MEDICARE: JESSICA LAIBSON SCHMOLL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC005396	GA
2	101YM0800X	Mental Health Counselor	005396	GA

General Provider Information

NPI Number	:	1467766360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LAIBSON SCHMOLL LPC

Provider Business Mailing Address
First Line	:	122 W TRINITY PL APT 3305
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-3593
Country	:	US
Telephone Number	:	404-449-6199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 LINCOLN PKWY E STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30346-2209
Country	:	US
Telephone Number	:	404-449-6199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	11/07/2023

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