Provider Demographics
NPI:1720622848
Name:FERNANDEZ, JAMIE CAROL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:CAROL
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 MOSSWOOD LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3956
Mailing Address - Country:US
Mailing Address - Phone:770-312-6834
Mailing Address - Fax:
Practice Address - Street 1:317 W HILL ST STE 203B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4368
Practice Address - Country:US
Practice Address - Phone:470-207-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0062381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical