Provider Demographics
NPI:1053703942
Name:YATES, JORDAN (LPC)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:YATES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 PEACHTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2551
Mailing Address - Country:US
Mailing Address - Phone:470-359-4852
Mailing Address - Fax:
Practice Address - Street 1:5575 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2551
Practice Address - Country:US
Practice Address - Phone:470-359-4852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional