Individual
JERECIA AMANDA LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314
(912) 435-6965
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW006509
GA
1041C0700X
Clinical Social Worker
0904008952
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659424448
—
VA
Enumeration date
05/20/2015
Last updated
10/23/2018
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