Healthcare Provider Details

I. General information

NPI: 1801444260
Provider Name (Legal Business Name): JENNIFER HERRIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 50TH ST
TIFTON GA
31794-1568
US

IV. Provider business mailing address

710 50TH ST
TIFTON GA
31794-1568
US

V. Phone/Fax

Practice location:
  • Phone: 229-396-5885
  • Fax: 888-746-1787
Mailing address:
  • Phone: 229-396-5885
  • Fax: 888-746-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW006838
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006887
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: