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General NPI Number Information
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NPI Number | 1801250287
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Entity Type | Individual
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Provider Name | JENNIFER COOPER
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Gender | Female
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 1100 OLD DAWSON VILLAGE RD E SUITE 020
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City | DAWSONVILLE
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State | GA
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Zip | 30534-3806
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Country | US
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Telephone | 678-914-4334
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 OLD DAWSON VILLAGE RD E SUITE 020
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City | DAWSONVILLE
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State | GA
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Zip | 30534-3806
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APC005350
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License Number State | GA
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