Healthcare Provider Details

I. General information

NPI: 1255809083
Provider Name (Legal Business Name): JENNIFER LEIGH FARRAR LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 DUG GAP RD
DALTON GA
30720-5007
US

IV. Provider business mailing address

132 FARRAR RD
COHUTTA GA
30710-9705
US

V. Phone/Fax

Practice location:
  • Phone: 706-279-0405
  • Fax:
Mailing address:
  • Phone: 706-537-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC006554
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC012181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: