Provider Demographics
NPI:1922667039
Name:THREADCRAFT, JENEIFER (MS)
Entity Type:Individual
Prefix:
First Name:JENEIFER
Middle Name:
Last Name:THREADCRAFT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 MCKENZIE AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2893
Mailing Address - Country:US
Mailing Address - Phone:678-334-8645
Mailing Address - Fax:
Practice Address - Street 1:1775 PARKER RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6654
Practice Address - Country:US
Practice Address - Phone:678-334-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling