| Doctor Name: | JORDAN YATES |
| NPI Number: | 1053703942 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, NCC |
| License Number: | 007794 |
| Business Practice Address: | 2750 Old Alabama Rd Suite 200 Johns Creek, GA - 300228593 |
| Business Phone Number: | 6788935300 |
| Business Fax Number: | |
| Mailing Address: | 2750 Old Alabama Rd, Suite 200 JOHNS CREEK |
| State: | GA |
| Postal Code: | 300228593 |
| Phone Number: | 6788935300 |
| Fax Number: | |
| NPI Enumeration Date: | 03/02/2015 |
| NPI Last Update Date: | 03/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 007794 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |