Provider Demographics
NPI:1720572886
Name:HAMA, JENNIFER DREIBELBIS (LPC, CPCS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DREIBELBIS
Last Name:HAMA
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 SUMMIT RIDGE PKWY STE 503
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1621
Mailing Address - Country:US
Mailing Address - Phone:770-325-0447
Mailing Address - Fax:
Practice Address - Street 1:3460 SUMMIT RIDGE PKWY STE 503
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1621
Practice Address - Country:US
Practice Address - Phone:770-325-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366849820OtherNPI2