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NPI Code Detail

MEDICARE: RITA JEZIORSKI LPC

MEDICARE: RITA JEZIORSKI 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
1101YM0800XMental Health CounselorLPC003714GA

General Provider Information

NPI Number : 1548323918
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA JEZIORSKI LPC
Provider Business Mailing Address
First Line : 1401 BURLEYSON DR
Second Line :
City : DALTON
State : GA
Zip : 30720-2522
Country : US
Telephone Number : 706-270-5002
Fax Number : 706-270-5111
Provider Business Practice Location Address
First Line : 191 LAMAR HALEY PKWY
Second Line :
City : CANTON
State : GA
Zip : 30114-8019
Country : US
Telephone Number : 706-704-1600
Fax Number : 770-704-1611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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Directions to “ RITA JEZIORSKI LPC” Practice Location

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