Provider Demographics
NPI:1134456700
Name:JENNIFER CRUMBLEY PSYD INC.
Entity Type:Organization
Organization Name:JENNIFER CRUMBLEY PSYD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRUMBLEY-DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:678-838-9336
Mailing Address - Street 1:8304 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6935
Mailing Address - Country:US
Mailing Address - Phone:678-838-9336
Mailing Address - Fax:678-838-3619
Practice Address - Street 1:8304 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6935
Practice Address - Country:US
Practice Address - Phone:678-838-9336
Practice Address - Fax:678-838-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002623103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000966633DMedicaid