Provider Demographics
NPI:1891207999
Name:JENNINGS, THOMAS B JR (MS, LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:JENNINGS
Suffix:JR
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2726
Mailing Address - Country:US
Mailing Address - Phone:850-261-5137
Mailing Address - Fax:
Practice Address - Street 1:75 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2726
Practice Address - Country:US
Practice Address - Phone:850-261-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009872101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor