Provider Demographics
NPI:1639592991
Name:JERNIGAN, EMILY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 FONTAINE PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5144
Mailing Address - Country:US
Mailing Address - Phone:601-382-2662
Mailing Address - Fax:
Practice Address - Street 1:407 FONTAINE PL
Practice Address - Street 2:SUITE 102
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5144
Practice Address - Country:US
Practice Address - Phone:601-382-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional