Provider Demographics
NPI:1750506952
Name:HOPKINS, JACQUELINE BREWER (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BREWER
Last Name:HOPKINS
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 1:215 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-4249
Mailing Address - Country:US
Mailing Address - Phone:229-276-0100
Mailing Address - Fax:229-276-0300
Practice Address - Street 1:215 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-4249
Practice Address - Country:US
Practice Address - Phone:229-276-0100
Practice Address - Fax:229-276-0300
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC4517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA614588062AMedicaid