Provider Demographics
NPI:1548731193
Name:ACKER, JENNIFER (MA, LPC, NCC, CMAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ACKER
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SILVERTHORNE PT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6828
Mailing Address - Country:US
Mailing Address - Phone:586-846-1014
Mailing Address - Fax:
Practice Address - Street 1:275 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4877
Practice Address - Country:US
Practice Address - Phone:678-805-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005730101YM0800X
GALPC011114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health