Provider Demographics
NPI:1689943581
Name:LONDON, JENNIFER G (LPC NCC CAADC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:G
Last Name:LONDON
Suffix:
Gender:F
Credentials:LPC NCC CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 WEALTHY ST SE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2762
Mailing Address - Country:US
Mailing Address - Phone:616-485-5952
Mailing Address - Fax:616-451-3070
Practice Address - Street 1:1514 WEALTHY ST. SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506
Practice Address - Country:US
Practice Address - Phone:616-485-5952
Practice Address - Fax:616-451-3070
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI204309101YA0400X
MI6401010366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)