| Doctor Name: | MRS. JESSICA DIANE ROOT |
| NPI Number: | 1013249846 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCA |
| License Number: | LPC006368 |
| Business Practice Address: | 378 Tabor Rd Fort Valley, GA - 310306024 |
| Business Phone Number: | 4789714684 |
| Business Fax Number: | |
| Mailing Address: | 378 Tabor Rd, FORT VALLEY |
| State: | GA |
| Postal Code: | 310306024 |
| Phone Number: | 4789714684 |
| Fax Number: | 4789714685 |
| NPI Enumeration Date: | 02/04/2010 |
| NPI Last Update Date: | 08/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC006368 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |