MEDICARE: MS. SHERRI JACKS 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	101YP2500X	Professional Counselor	LPC003038	GA

General Provider Information

NPI Number	:	1902812886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERRI JACKS LPC

Provider Business Mailing Address
First Line	:	8250 CANYON FORGE DR
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4469
Country	:	US
Telephone Number	:	770-603-5921
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 LAKEWOOD WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-6022
Country	:	US
Telephone Number	:	404-762-3650
Fax Number	:	404-624-0638

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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