Provider Demographics
NPI:1790940484
Name:MANN-MACKEY, JENNIFER C (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:MANN-MACKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:C
Other - Last Name:MANN-MACKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0037
Mailing Address - Country:US
Mailing Address - Phone:912-385-2627
Mailing Address - Fax:912-385-2628
Practice Address - Street 1:1245 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-7729
Practice Address - Country:US
Practice Address - Phone:912-385-2627
Practice Address - Fax:912-385-2628
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA359579212BMedicaid