Provider Demographics
NPI:1609362920
Name:BECKMAN, JENIFER NICOLE (LPC, ACS, RPT, NCC)
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:NICOLE
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:LPC, ACS, RPT, NCC
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:WILLENZIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4074 N SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1658
Mailing Address - Country:US
Mailing Address - Phone:704-578-7728
Mailing Address - Fax:
Practice Address - Street 1:1017 FAYETTEVILLE RD SE # B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2932
Practice Address - Country:US
Practice Address - Phone:404-486-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GALPC0012309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health