Provider Demographics
NPI:1760565899
Name:JENNINGS, JOLIE A (MA, LPCI)
Entity Type:Individual
Prefix:MS
First Name:JOLIE
Middle Name:A
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MA, LPCI
Other - Prefix:MS
Other - First Name:JOLIE
Other - Middle Name:ANGELL
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:105 WILLIM ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5231
Mailing Address - Country:US
Mailing Address - Phone:210-467-8808
Mailing Address - Fax:210-822-5960
Practice Address - Street 1:105 WILLIM ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5231
Practice Address - Country:US
Practice Address - Phone:210-822-5959
Practice Address - Fax:210-822-5960
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62389101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor