Healthcare Provider Details

I. General information

NPI: 1427718501
Provider Name (Legal Business Name): JENNIFER NOEL GAUL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BUFORD HWY NE STE 100
BROOKHAVEN GA
30329-2146
US

IV. Provider business mailing address

2801 BUFORD HWY NE STE 100
BROOKHAVEN GA
30329-2146
US

V. Phone/Fax

Practice location:
  • Phone: 678-820-7830
  • Fax: 678-373-0339
Mailing address:
  • Phone: 678-820-7830
  • Fax: 678-373-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014892
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: