Provider Demographics
NPI:1548919608
Name:LOGGINS, JENNIFER WILSON (LPC CPCS)
Entity type:Individual
Prefix:PROF
First Name:JENNIFER
Middle Name:WILSON
Last Name:LOGGINS
Suffix:
Gender:F
Credentials:LPC CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2968 SKY LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2265
Mailing Address - Country:US
Mailing Address - Phone:678-617-6546
Mailing Address - Fax:
Practice Address - Street 1:2968 SKY LAKE CIR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-2265
Practice Address - Country:US
Practice Address - Phone:678-617-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional