Provider Demographics
NPI:1417176371
Name:JENNINGS, GERALD D (PH D , LPC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:D
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:PH D , LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4268
Mailing Address - Country:US
Mailing Address - Phone:706-295-0440
Mailing Address - Fax:706-368-6971
Practice Address - Street 1:308 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4268
Practice Address - Country:US
Practice Address - Phone:706-295-0440
Practice Address - Fax:706-368-6971
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC0736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health