Provider Demographics
NPI:1225360506
Name:APPLE, JERI LYNN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JERI
Middle Name:LYNN
Last Name:APPLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:GA
Mailing Address - Zip Code:30184-0481
Mailing Address - Country:US
Mailing Address - Phone:678-988-1656
Mailing Address - Fax:
Practice Address - Street 1:175 PINE GROVE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8483
Practice Address - Country:US
Practice Address - Phone:678-988-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0005801041C0700X
GA000577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist