Provider Demographics
NPI:1023345634
Name:BROOKS, JENNIFER LYNNE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:HIGGINS-BROOKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:1100 KNOTT ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3124
Mailing Address - Country:US
Mailing Address - Phone:404-579-1934
Mailing Address - Fax:404-627-2176
Practice Address - Street 1:1100 KNOTT ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3124
Practice Address - Country:US
Practice Address - Phone:404-579-1934
Practice Address - Fax:404-627-2176
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12016853OtherCENPATICO