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General NPI Number Information
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NPI Number | 1245688241
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Entity Type | Individual
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Provider Name | JENNIFER SCOTT SUDDERTH LPC
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Gender | Female
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 745 S MILLEDGE AVE STE A
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City | ATHENS
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State | GA
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Zip | 30605-1291
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Country | US
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Telephone | 770-389-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 1737 HEWELL RD NW
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City | DEWY ROSE
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State | GA
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Zip | 30634-2956
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Country | US
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Telephone | 706-371-4020
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 012819
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC012819
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7371
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License Number State | SC
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