Provider Demographics
NPI:1003659160
Name:TIMBERLAKE, JENNIFER STANLEY (LAPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:STANLEY
Last Name:TIMBERLAKE
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 1:2405 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-1103
Mailing Address - Country:US
Mailing Address - Phone:706-464-6560
Mailing Address - Fax:
Practice Address - Street 1:2920 MACON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2204
Practice Address - Country:US
Practice Address - Phone:706-507-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor