Provider Demographics
NPI:1801026364
Name:MCIVER, JENNY MAE (LMFT,MAC)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:MAE
Last Name:MCIVER
Suffix:
Gender:F
Credentials:LMFT,MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 WILL SMITH RD
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31798-4513
Mailing Address - Country:US
Mailing Address - Phone:912-383-5924
Mailing Address - Fax:
Practice Address - Street 1:2935 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1777
Practice Address - Country:US
Practice Address - Phone:229-333-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-18
Last Update Date:2009-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000919106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist