MEDICARE: DR. JUANESSA DONYALE BOOKER LPC, EDD

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	011933	GA

General Provider Information

NPI Number	:	1831854827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUANESSA DONYALE BOOKER LPC, EDD

Provider Business Mailing Address
First Line	:	725 SMALL ELK CT
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1022
Country	:	US
Telephone Number	:	470-771-2645
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 SMALL ELK CT
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1022
Country	:	US
Telephone Number	:	470-771-2645
Fax Number	:

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

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	11/03/2021

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