Provider Demographics
NPI:1497922488
Name:MANLY, JENNIFER JOHNSON (LAPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOHNSON
Last Name:MANLY
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PERIMETER CENTER PKWY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1308
Mailing Address - Country:US
Mailing Address - Phone:770-350-3500
Mailing Address - Fax:770-350-3510
Practice Address - Street 1:211 PERIMETER CENTER PKWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-1308
Practice Address - Country:US
Practice Address - Phone:770-350-3500
Practice Address - Fax:770-350-3510
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 005378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional