Active NPI
Jaclyn Ethridge, LPC
- Professional Counselor
- Griffin, GA
National Provider Identifier
1205319241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC010462
- Practice address
- 1574 Williamson Rd
Griffin, GA 30224-3931 - Phone
- (770) 358-5252
- NPI assigned
- Sep 14, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC010462 | GA | Primary |
Addresses
Primary practice location
1574 Williamson Rd
Griffin, GA 30224-3931
Mailing address
1574 Williamson Rd
Griffin, GA 30224-3931
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC010462 | GA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McIntosh Trail Community Service Board | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Griffin, GA
- NPI 1295903862
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536883200000",
"number": "1205319241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1574 WILLIAMSON RD",
"city": "GRIFFIN",
"state": "GA",
"postal_code": "302243931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1574 WILLIAMSON RD",
"city": "GRIFFIN",
"state": "GA",
"postal_code": "302243931",
"telephone_number": "770-358-5252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETHRIDGE",
"first_name": "JACLYN",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-14",
"last_updated": "2018-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC010462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Griffin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.