Provider Demographics
NPI:1134560287
Name:LESTER, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831498
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-0025
Mailing Address - Country:US
Mailing Address - Phone:404-287-8556
Mailing Address - Fax:404-891-5765
Practice Address - Street 1:3300 BUCKEYE RD
Practice Address - Street 2:SUITE 527
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4229
Practice Address - Country:US
Practice Address - Phone:404-287-8556
Practice Address - Fax:404-891-5765
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional