MEDICARE: JESSICA DEBOYIA LAWRENCE

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	101Y00000X	Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1891122230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DEBOYIA LAWRENCE

Provider Business Mailing Address
First Line	:	1624 EMERALD AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1510
Country	:	US
Telephone Number	:	678-670-8434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 EMERALD AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1510
Country	:	US
Telephone Number	:	678-670-8434
Fax Number	:

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

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	01/23/2014

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Directions to “ JESSICA DEBOYIA LAWRENCE ” Practice Location

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