Provider Information for 1174911275
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JESSICA WINGO LEATHERWOOD LPC
Sex: Female
NPI: 1174911275
Last Updated: 2014-12-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1174911275 | ||||||||
| Enumeration Date | 2014-12-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 62 COALING RD CEDARTOWN, GA 30125-6100 United States Phone: 770-842-7172 | Fax: | ||||||||
| Primary Practice Address | 62 COALING RD CEDARTOWN, GA 30125-6100 United States Phone: 770-842-7172 | Fax: | ||||||||
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