| Doctor Name: | MR. JERRY THOMAS MOTE |
| NPI Number: | 1568589349 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | LPC004699 |
| Business Practice Address: | 6250 Ringgold Rd East Ridge, TN - 374123857 |
| Business Phone Number: | 4233645853 |
| Business Fax Number: | |
| Mailing Address: | 5905 Wellworth Ave, EAST RIDGE |
| State: | TN |
| Postal Code: | 374123647 |
| Phone Number: | 4233645853 |
| Fax Number: | |
| NPI Enumeration Date: | 03/25/2007 |
| NPI Last Update Date: | 02/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC004699 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |