Provider Demographics
NPI:1366637597
Name:BOONE, JENNIFER ROSS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROSS
Last Name:BOONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HUNTINGTON RD STE 703
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7214
Mailing Address - Country:US
Mailing Address - Phone:706-425-8900
Mailing Address - Fax:706-425-8600
Practice Address - Street 1:1 HUNTINGTON RD STE 703
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7214
Practice Address - Country:US
Practice Address - Phone:706-425-8900
Practice Address - Fax:706-425-8600
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0033601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical