Provider Demographics
NPI:1679919369
Name:VELEZ, ANNE JERNIGAN (EDS, LPC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:JERNIGAN
Last Name:VELEZ
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4158 D YOUVILLE TRCE
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1433
Mailing Address - Country:US
Mailing Address - Phone:706-483-2799
Mailing Address - Fax:
Practice Address - Street 1:4158 D YOUVILLE TRCE
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-1433
Practice Address - Country:US
Practice Address - Phone:706-483-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006083101YP2500X
GA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool