MEDICARE: JENNIFER WOOLARD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	005974	GA
3	1041C0700X	Clinical Social Worker	005974	GA

General Provider Information

NPI Number	:	1033473673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WOOLARD LCSW

Provider Business Mailing Address
First Line	:	822 PINHURST DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5816
Country	:	US
Telephone Number	:	845-536-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 HIGHTOWER TRL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-6244
Country	:	US
Telephone Number	:	845-536-0654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	08/09/2017

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