Provider Demographics
NPI:1538593579
Name:JAYNES, AMY FOWLER (MS, LPC, NCC, CRC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:FOWLER
Last Name:JAYNES
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GOVERNORS SQ STE B
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4862
Mailing Address - Country:US
Mailing Address - Phone:770-451-0404
Mailing Address - Fax:
Practice Address - Street 1:130 GOVERNORS SQ STE B
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4862
Practice Address - Country:US
Practice Address - Phone:770-451-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional