Provider Demographics
NPI:1144355546
Name:DALEY, JENNIFER PORTERFIELD (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PORTERFIELD
Last Name:DALEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:PORTERFIELD
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3575 MACON RD STE 18
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-8236
Mailing Address - Country:US
Mailing Address - Phone:706-565-5927
Mailing Address - Fax:706-565-8207
Practice Address - Street 1:3575 MACON RD STE 18
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-8236
Practice Address - Country:US
Practice Address - Phone:706-565-5927
Practice Address - Fax:706-565-8207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006102101YP2500X
AL2684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional