Provider Demographics
NPI:1760548986
Name:HOSEA, JENNIFER M (MED, LPC, RPT-S)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HOSEA
Suffix:
Gender:F
Credentials:MED, LPC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLD DAWSON VILLAGE RD E
Mailing Address - Street 2:SUITE 020
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-3806
Mailing Address - Country:US
Mailing Address - Phone:678-231-3105
Mailing Address - Fax:
Practice Address - Street 1:1100 OLD DAWSON VILLAGE RD E
Practice Address - Street 2:SUITE 020
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-3806
Practice Address - Country:US
Practice Address - Phone:678-231-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional