Provider Demographics
NPI:1184210346
Name:WOOD, JENNY MARI (LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:MARI
Last Name:WOOD
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 1:163 APPLE LN
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4672
Mailing Address - Country:US
Mailing Address - Phone:770-833-1055
Mailing Address - Fax:
Practice Address - Street 1:163 APPLE LN
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4672
Practice Address - Country:US
Practice Address - Phone:770-833-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005044101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005044OtherLICENSED PROFESSIONAL COUNSELOR