Provider Demographics
NPI:1902324619
Name:NESTOR-CARDWELL, JENNIFER (LPC, ATR)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:NESTOR-CARDWELL
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 CASTLETON DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2001
Mailing Address - Country:US
Mailing Address - Phone:404-931-6334
Mailing Address - Fax:
Practice Address - Street 1:1708 PEACHTREE ST NW STE 204
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2416
Practice Address - Country:US
Practice Address - Phone:678-222-2987
Practice Address - Fax:678-222-2987
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional