Provider Demographics
NPI:1164161014
Name:JENNINGS, KHARESEA BECKWORTH (LCSW)
Entity Type:Individual
Prefix:
First Name:KHARESEA
Middle Name:BECKWORTH
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 RIDGEWOOD CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-3483
Mailing Address - Country:US
Mailing Address - Phone:678-913-9554
Mailing Address - Fax:
Practice Address - Street 1:4720 RIDGEWOOD CREEK DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-3483
Practice Address - Country:US
Practice Address - Phone:678-913-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0079031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical