Individual
MR. JOSEPH J FENNELL II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
19 CHURCH ST, STATESBORO, GA 30458-5385
(912) 489-7590
(912) 489-3877
Mailing address
19 CHURCH ST, STATESBORO, GA 30458-5385
(912) 489-7590
(912) 489-3877
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
APC001843
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01422484
AMERIGROUP
GA
01
—
690639
WELLCARE
GA
Enumeration date
12/26/2009
Last updated
06/19/2013
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