Healthcare Provider Details

I. General information

NPI: 1144591413
Provider Name (Legal Business Name): JENNIFER A ENSLOW LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 OLD RIVER RD
BLOOMINGDALE GA
31302-8109
US

IV. Provider business mailing address

PO BOX 807
EDEN GA
31307-0807
US

V. Phone/Fax

Practice location:
  • Phone: 912-441-5497
  • Fax:
Mailing address:
  • Phone: 912-441-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.61181864
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006682
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: