Jacqueline Latricia Slack, LPC, NCC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LPC005620 Issued in GA

Practice address

80 Joseph E Lowery Blvd NW
Atlanta, GA 30314-3421

Phone

(404) 226-7553

NPI assigned

Jul 18, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Families First

  • Clinical Social Worker
  • Atlanta, GA
  • NPI 1477687507
  NPD
• Families First

  • Community/Behavioral Health Agency
  • Smyrna, GA
  • NPI 1790988475
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1871806992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5810",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311070810",
            "telephone_number": "404-226-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 JOSEPH E LOWERY BLVD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303143421",
            "telephone_number": "404-226-7553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9 Kelso At Peyton Dr SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303111721",
            "country_code": "US",
            "telephone_number": "404-226-7553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SLACK",
        "first_name": "JACQUELINE",
        "middle_name": "LATRICIA",
        "credential": "LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-18",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": "LPC005620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skyland Hi
• Skylark Adh-Atlanta LLC
• Skylark Adh-Powers Ferry, LLC
• Skyline EMS LLC
• Skyye Skynn LLC
• Kailyn Slack, NP
• Angela Slade
• Daraus Amaria Slade, NP
• Abigail Goodwin Sladek, APRN,AGPCNP-BC
• Elizabeth Dawson Slaney

• Counselor in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.