Provider Demographics
NPI:1346851086
Name:LUMPKIN, JEANNINE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:MARIE
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:MARIE
Other - Last Name:MINOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5065 POND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-1887
Mailing Address - Country:US
Mailing Address - Phone:407-920-1876
Mailing Address - Fax:
Practice Address - Street 1:5065 POND VIEW DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-1887
Practice Address - Country:US
Practice Address - Phone:407-920-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional