Provider Demographics
NPI:1285756668
Name:HUDDLESTON, JENNIFER M (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ELLEN
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:165 BRADFORD SQ STE D
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1960
Mailing Address - Country:US
Mailing Address - Phone:678-410-6874
Mailing Address - Fax:
Practice Address - Street 1:165 BRADFORD SQ STE D
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1960
Practice Address - Country:US
Practice Address - Phone:678-410-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC001502101YM0800X
GALPC005784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health