Provider Demographics
NPI:1588951578
Name:KUCK, JENNIFER FARNSWORTH (LMFT, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FARNSWORTH
Last Name:KUCK
Suffix:
Gender:F
Credentials:LMFT, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 NORTHRIDGE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3207
Mailing Address - Country:US
Mailing Address - Phone:770-771-6900
Mailing Address - Fax:770-771-6901
Practice Address - Street 1:365 NORTHRIDGE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3207
Practice Address - Country:US
Practice Address - Phone:770-771-6900
Practice Address - Fax:770-771-6901
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006905101YP2500X
GAMFT001323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional