Provider Demographics
NPI:1023661519
Name:GARLICK, JONATHAN C (LPC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:C
Last Name:GARLICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 GOLDEN SPRINGS RD # 301
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6924
Mailing Address - Country:US
Mailing Address - Phone:256-365-3401
Mailing Address - Fax:
Practice Address - Street 1:1300 NOBLE ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4643
Practice Address - Country:US
Practice Address - Phone:256-365-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2304101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2304OtherLICENSED PROFESSIONAL COUNSELOR