Provider Demographics
NPI:1770957433
Name:JENNIFER HERRIN, LPC
Entity type:Organization
Organization Name:JENNIFER HERRIN, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:INGERSOLL
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-258-3473
Mailing Address - Street 1:400 MAIN STREET, COTTAGE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522
Mailing Address - Country:US
Mailing Address - Phone:912-258-3473
Mailing Address - Fax:888-459-9707
Practice Address - Street 1:400 MAIN STREET, COTTAGE 1
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522
Practice Address - Country:US
Practice Address - Phone:912-258-3473
Practice Address - Fax:888-459-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008529251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health