Provider Demographics
NPI:1679204051
Name:GOULD, JENNA M (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:GOULD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ARIZONA AVE NE UNIT 315
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2256
Mailing Address - Country:US
Mailing Address - Phone:770-841-4158
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY
Practice Address - Street 2:SUITE 540
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:770-841-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker