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NPI Code Detail

MEDICARE: MS. JENNIFER ELISHA TEAGUE M.A., LPC

MEDICARE: MS. JENNIFER ELISHA TEAGUE M.A., LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor005083GA
2101YP2500XProfessional CounselorLPC005083GA

General Provider Information

NPI Number : 1669638318
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER ELISHA TEAGUE M.A., LPC
Provider Business Mailing Address
First Line : 1944 BRANNAN RD
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-4310
Country : US
Telephone Number : 404-786-6647
Fax Number :
Provider Business Practice Location Address
First Line : 1944 BRANNAN RD
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-4310
Country : US
Telephone Number : 404-786-6647
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2008
Last Update Date : 04/05/2025

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