Provider Demographics
NPI:1134474620
Name:WINDOM, JOCLYN SIMS (LPC)
Entity type:Individual
Prefix:
First Name:JOCLYN
Middle Name:SIMS
Last Name:WINDOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 MALL PKWY
Mailing Address - Street 2:STE 101-334
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6993
Mailing Address - Country:US
Mailing Address - Phone:678-508-1935
Mailing Address - Fax:770-323-1983
Practice Address - Street 1:11720 AMBER PARK DR STE 160
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2271
Practice Address - Country:US
Practice Address - Phone:334-552-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014262101YM0800X, 101YP2500X
171400000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA743527131AMedicaid