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General NPI Number Information
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NPI Number | 1508431966
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Entity Type | Organization
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Legal Business Name | AMY JACQUES LLC
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 610 CANDLER ST
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City | GAINESVILLE
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State | GA
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Zip | 30501-3334
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Country | US
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Telephone | 678-632-6169
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Fax | 678-943-1197
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Provider Business Mailing Address
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Address Line | 2565 THOMPSON BRIDGE RD STE 111
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City | GAINESVILLE
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State | GA
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Zip | 30501-1723
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Country | US
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Telephone | 678-632-6169
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | AMY JACQUES
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Credential | LPC
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Telephone | 678-632-6169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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