Individual
JENNIFER M CISCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
386 PINE ST NE, ATLANTA, GA 30308-2532
(251) 753-3508
Mailing address
106 OZARK TRL, CANTON, GA 30114-8847
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT001566
GA
Other
Enumeration date
07/17/2017
Last updated
03/17/2018
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