Provider Demographics
NPI:1114540911
Name:JENNINGS, DANA (EDS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:EDS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 HIGHWAY 70 S APT 216
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-5236
Mailing Address - Country:US
Mailing Address - Phone:770-315-9033
Mailing Address - Fax:
Practice Address - Street 1:1505 ASHBROOKE TRCE
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-1306
Practice Address - Country:US
Practice Address - Phone:770-315-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional