Provider Demographics
NPI:1073359527
Name:SERRANO, JENNIFER LEIGH (MS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BLAKE CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2141
Mailing Address - Country:US
Mailing Address - Phone:404-709-8735
Mailing Address - Fax:
Practice Address - Street 1:224 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1112
Practice Address - Country:US
Practice Address - Phone:770-893-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional