Provider Demographics
NPI:1922446640
Name:AVOLI, JENNIFER LEAKE (PCC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEAKE
Last Name:AVOLI
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2536
Mailing Address - Country:US
Mailing Address - Phone:614-893-5447
Mailing Address - Fax:
Practice Address - Street 1:2700 E MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2536
Practice Address - Country:US
Practice Address - Phone:614-893-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health