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Individual

JENNIFER WALLACE MERRILL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LAPC

Contact information

Practice address
120 HANDLEY RD, TYRONE, GA 30290-2177
(770) 486-1011
Mailing address
120 HANDLEY RD, TYRONE, GA 30290-2177
(770) 486-1011

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
APC002988
GA
101YM0800X
Mental Health Counselor
Primary
LPC007657
GA

Other

Enumeration date
11/04/2011
Last updated
02/11/2014
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