Provider Demographics
NPI:1154858124
Name:ZAK, JENNIFER MARY (LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARY
Last Name:ZAK
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 1:105 DALTON CODY DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2928
Mailing Address - Country:US
Mailing Address - Phone:912-399-2475
Mailing Address - Fax:
Practice Address - Street 1:664 SCRANTON RD STE 201
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1947
Practice Address - Country:US
Practice Address - Phone:912-996-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional