Basic Information
| Provider Information | |||||||||
| NPI: | 1932474640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTGOMERY | ||||||||
| FirstName: | JANIKA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1830 WATER PL SE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303392042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709169031 | ||||||||
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| Practice Location | |||||||||
| Address1: | 284 S MAIN ST STE 800 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782643988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2012 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | APC003345 | GA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | LPC008958 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.