MEDICARE: JAMESETTER LUESINDER CREDELL 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	101YM0800X	Mental Health Counselor	8217	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790914000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMESETTER LUESINDER CREDELL LPC

Provider Business Mailing Address
First Line	:	PO BOX 746724
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6724
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2668 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5655
Country	:	US
Telephone Number	:	336-200-7020
Fax Number	:

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

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	10/18/2024

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