Lavonna Winfreda Owens-Jackson, LPC, CCM

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC008416 Issued in GA

Practice address

1192 Rockbridge Rd Ste a
Stone Mountain, GA 30087-2923

Phone

(770) 925-2010

NPI assigned

Apr 21, 2022

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

Other names 1

• Mrs. Lavonna Small Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1891439337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 LAKESIDE CIR",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300168892",
            "telephone_number": "678-478-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1192 ROCKBRIDGE RD STE A",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300872923",
            "telephone_number": "770-925-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWENS-JACKSON",
        "first_name": "LAVONNA",
        "middle_name": "WINFREDA",
        "name_prefix": "Ms.",
        "credential": "LPC, CCM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-21",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAVONNA",
            "last_name": "SMALL",
            "prefix": "MRS.",
            "credential": "LPC, CCM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Odion Patience Osayimwen, NP
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• Nnenna Beatrice Otaluka, NP
• Kofi Oteng Gyang, O.D
• Stephanie L Overton
• Beverli Simone Owens, LAT, ATC
• Melvin Douglas Owens, DOCTOR OF PHARMACY
• Jonathan Pace, EMT-I
• Sharla M Palmer, OTR
• Paradise for Living Services, Inc.

• Professional Counselor in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; 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.