Provider Demographics
NPI:1083050579
Name:WATTS, JENNIFER A (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:WATTS
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LENOX POINTE NE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-7420
Mailing Address - Country:US
Mailing Address - Phone:404-266-0962
Mailing Address - Fax:404-266-8687
Practice Address - Street 1:25 LENOX POINTE NE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-7420
Practice Address - Country:US
Practice Address - Phone:404-266-0962
Practice Address - Fax:404-266-8687
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT-001075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist