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General NPI Number Information
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NPI Number | 1003532003
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Entity Type | Individual
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Provider Name | MS. JAIME PENN
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Gender | Female
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 2226 ACAPULCO DR APT C
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City | AUGUSTA
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State | GA
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Zip | 30906-2376
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Country | US
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Telephone | 706-750-9442
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16441
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City | AUGUSTA
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State | GA
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Zip | 30919-2441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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