Individual
JASON NIETZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
132 STEPHENSON AVE STE 101, SAVANNAH, GA 31405-5829
(912) 200-3195
Mailing address
132 STEPHENSON AVE STE 101, SAVANNAH, GA 31405-5829
(912) 200-3195
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
007803
GA
Other
Enumeration date
05/29/2014
Last updated
05/29/2014
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