Provider Demographics
NPI:1134575640
Name:DRABOWICZ, JENNIFER (EDD, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DRABOWICZ
Suffix:
Gender:F
Credentials:EDD, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 POPLAR AVE STE 413
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4434
Mailing Address - Country:US
Mailing Address - Phone:901-262-7950
Mailing Address - Fax:
Practice Address - Street 1:4646 POPLAR AVE STE 413
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4434
Practice Address - Country:US
Practice Address - Phone:901-262-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026466Medicaid