Provider Demographics
NPI:1134183809
Name:MECK, JENNIFER L (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MECK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:MECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAPC
Mailing Address - Street 1:2278 MOODY RD STE D
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-1933
Mailing Address - Country:US
Mailing Address - Phone:478-929-0294
Mailing Address - Fax:478-923-9770
Practice Address - Street 1:2278 MOODY RD STE D
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-1933
Practice Address - Country:US
Practice Address - Phone:478-929-0294
Practice Address - Fax:478-923-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional