Provider Demographics
NPI:1316174212
Name:ALVAREZ, JENNIFER LICHTENBERG (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LICHTENBERG
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:LICHTENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:3540 WHEELER RD STE 619
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-395-8610
Practice Address - Street 1:3540 WHEELER RD STE 619
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6534
Practice Address - Country:US
Practice Address - Phone:706-395-8606
Practice Address - Fax:706-395-8610
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist