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NPI Code Detail

MEDICARE: ENJ COUNSELING, LLC

MEDICARE: ENJ COUNSELING, LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)LPC006931GA

General Provider Information

NPI Number : 1902320542
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENJ COUNSELING, LLC
Provider Business Mailing Address
First Line : 371 ROSEMONT RD
Second Line :
City : LAGRANGE
State : GA
Zip : 30241-9544
Country : US
Telephone Number : 706-594-3458
Fax Number :
Provider Business Practice Location Address
First Line : 200 N LEWIS ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2738
Country : US
Telephone Number : 706-887-5787
Fax Number : 706-780-5402
Authorized Official
Title or Position : OWNER
Name : EMILY NANETTE JACKSON
Credential : LPC, NCC, CSOTS
Telephone Number : 706-594-3458
Provider Enumeration Date : 07/26/2017
Last Update Date : 03/04/2020

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