Provider Demographics
NPI:1669755989
Name:HARVEY, JACINTA Y (LAPC)
Entity type:Individual
Prefix:MS
First Name:JACINTA
Middle Name:Y
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N PATTERSON ST STE D
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2573
Mailing Address - Country:US
Mailing Address - Phone:229-244-1707
Mailing Address - Fax:
Practice Address - Street 1:2200 N PATTERSON ST STE D
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2573
Practice Address - Country:US
Practice Address - Phone:229-244-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional