Individual
AMY JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, BC-DMT
Contact information
Practice address
610 CANDLER ST, GAINESVILLE, GA 30501-3334
(678) 632-6169
(678) 943-1197
Mailing address
3446 WINDER HWY STE M, FLOWERY BRANCH, GA 30542-3002
(678) 632-6169
(678) 943-1197
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC012102
GA
Other
Enumeration date
05/08/2021
Last updated
03/30/2023
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