JACQUELINE ALEXANDRA LILLY (NPI# 1205479490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205479490 |
| Entity Type | Individual |
| Full Name | JACQUELINE ALEXANDRA LILLY |
| Other Name | JACQUELINE ALEXANDRA RYANCZAK |
| Credential | LPC |
| Practice Address |
700 Churchill Ct Ste 110 Woodstock GA 30188-6880 |
| Mailing Address |
1734 Tappahannock Trl Marietta GA 30062-2087 |
| Practice Telephone | 7702849092 |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2019-10-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114035516 | Jacqueline Diane Lilly | Clinical Nurse Specialist | 102 West Utica Street, Oswego, NY 13126 | 2006-08-26 |
| Street Address |
700 CHURCHILL CT STE 110 |
| City | WOODSTOCK |
| State | GA |
| Zip Code | 30188-6880 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457901340 | Esfahani Enterprises LLC | Counselor | 700 Churchill Ct Ste 110, Woodstock, GA 30188-6880 | 2019-09-12 |
| 1760092019 | Michelle Wrayanne Glaze Parker | Counselor | 700 Churchill Ct Ste 110, Woodstock, GA 30188-6880 | 2020-08-02 |
| 1053929786 | Thriveworks Woodstock | Clinic/Center | 700 Churchill Ct Ste 110, Woodstock, GA 30188-6880 | 2020-07-20 |
| 1295357028 | Deshawn Renarda Artis | Counselor | 700 Churchill Ct Ste 110, Woodstock, GA 30188-6880 | 2020-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730715814 | Tyler Rose | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 116 South Mill Creek Court, Woodstock, GA 30188 | 2020-03-20 |
| 1881224897 | Dr. Tom LLC | Clinic/Center | 5431 Old Highway 5 Ste 206, Holly Springs, GA 30188 | 2020-01-17 |
| 1467090175 | Stacey Robin Hill | Dietitian, Registered | 210 Mcaffee St, Street Address 2, Woodstock, GA 30188 | 2019-12-12 |
| 1326681784 | Margo Vanderveen | Massage Therapist | 605 Old Hickory Road, Woodstock, GA 30188 | 2019-10-17 |
| 1275093437 | Rebekah Ruth Tchouta | Social Worker | 5166 Shotwell St, Woodstock, GA 30188 | 2019-03-23 |
| 1205395829 | Angela M Graves | Behavior Technician | 3229 S Cherokee Ln Ste 1400, Woodstock, GA 30188 | 2019-03-13 |
| 1396233391 | Costco Wholesale Corporation | Hearing Aid Equipment | 113 Lincoln Street, Woodstock, GA 30188 | 2018-04-25 |
| 1659878080 | Alexis K. Brown | Counselor | 3380 Trickum Rd., Bldg 700, Woodstock, GA 30188 | 2018-04-11 |
| 1427555440 | Lisa Marie Anthony | Specialist/Technologist | 400 Arnold Mill Rd, Woodstock, GA 30188 | 2018-04-06 |
| 1497254122 | J.a.h. Enterprises, LLC | Audiologist | 12195 Hwy. 92, Suite 114-325, Woodstock, GA 30188 | 2018-02-08 |
| Find all providers in zip 30188 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457901340 | Esfahani Enterprises LLC | Counselor | 700 Churchill Ct Ste 110, Woodstock, GA 30188-6880 | 2019-09-12 |
| 1710548730 | Tabitha Doyle | Counselor | 203 Woodpark Pl Bldg B2, Woodstock, GA 30188-3705 | 2019-06-21 |
| 1285107524 | Melissa Floyd Hall | Counselor | 4595 Towne Lake Pkwy Ste 150, Woodstock, GA 30189-5514 | 2019-01-09 |
| 1922526987 | Mckenna Smith | Counselor | 2031 Willow Brooke Dr Apt 2c, Woodstock, IL 60098-5211 | 2017-08-30 |
| 1114465713 | Tranquility Counseling Services, LLC | Counselor | 8744 Main St, Suite 303, Woodstock, GA 30188-4926 | 2017-02-03 |
| 1144772690 | Daniel Reid | Counselor | 202 Swanee Ln, Woodstock, GA 30188-7802 | 2016-11-01 |
| 1417400854 | Chelsea Vlcek | Counselor | 1211 Mitchell St, Woodstock, IL 60098-3641 | 2016-08-02 |
| 1861844128 | Chelsea Lynn Hill | Counselor | 226 Allison Dr, Woodstock, GA 30188-5729 | 2016-07-11 |
| 1588020044 | Brenda Mcburnie | Counselor | 255grimes Road, Woodstock, GA 30188 | 2016-01-13 |
| 1033599279 | Leah Tamar Epelbaum | Counselor | 203 Woodpark Pl Bldg B2nd, Woodstock, GA 30188-3705 | 2015-06-03 |
| Find all providers in WOODSTOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.