Individual
CRYSTAL JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44 BRAVES AVE, APT 4108, LAWRENCEVILLE, GA 30034
(317) 840-2643
Mailing address
44 BRAVES AVE, APT 4108, LAWRENCEVILLE, GA 30034
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
22-241572
GA
Other
Enumeration date
04/07/2023
Last updated
04/07/2023
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