Provider Demographics
NPI:1902950801
Name:ROTUNDA, JENNIFER W (LPC, LMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:W
Last Name:ROTUNDA
Suffix:
Gender:F
Credentials:LPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EARLHAM DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8538
Mailing Address - Country:US
Mailing Address - Phone:770-205-2676
Mailing Address - Fax:
Practice Address - Street 1:825 EARLHAM DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8538
Practice Address - Country:US
Practice Address - Phone:770-205-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004020101YM0800X
GA005466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health