Provider Demographics
NPI:1487307963
Name:MERIWETHER, JESSICA TEARA (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:TEARA
Last Name:MERIWETHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 SWAN TRCE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1664
Mailing Address - Country:US
Mailing Address - Phone:706-741-0506
Mailing Address - Fax:
Practice Address - Street 1:104 HARWELL AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3132
Practice Address - Country:US
Practice Address - Phone:706-837-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health