Individual
MISS JACQUELINE S CHILDRESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ME.D., LAPC
Contact information
Practice address
3100 CREPE MYRTLE CT APT B, ALBANY, GA 31721-6208
(229) 809-2674
Mailing address
3100 CREPE MYRTLE CT APT B, ALBANY, GA 31721-6208
(229) 809-2674
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
APC004295
GA
101YM0800X
Mental Health Counselor
Primary
LPC008933
GA
Other
Enumeration date
03/24/2014
Last updated
08/25/2016
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