Basic Information
| Provider Information | |||||||||
| NPI: | 1346414810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'LOUGHLIN | ||||||||
| FirstName: | JANNA | ||||||||
| MiddleName: | GILMER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GILMER | ||||||||
| OtherFirstName: | JANNA | ||||||||
| OtherMiddleName: | SUELLYN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 8824 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319088824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063203770 | ||||||||
| FaxNumber: | 7063203772 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 16TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063203770 | ||||||||
| FaxNumber: | 7063203772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | APC001948 | GA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPC006601 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.