Provider Demographics
NPI:1225160534
Name:ALEJANDRO, JENNIFER QUINTANILLA (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:QUINTANILLA
Last Name:ALEJANDRO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:QUINTANILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:618 PONDER PLACE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3117
Mailing Address - Country:US
Mailing Address - Phone:706-825-8491
Mailing Address - Fax:706-550-0340
Practice Address - Street 1:618 PONDER PLACE DR STE 2
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3117
Practice Address - Country:US
Practice Address - Phone:706-825-8491
Practice Address - Fax:706-550-0340
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health