Provider Demographics
NPI:1366542698
Name:HARCOURT, JENIFER T (LPC, CPCS)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:T
Last Name:HARCOURT
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:J
Other - Last Name:TUBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17313 BARBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4465
Mailing Address - Country:US
Mailing Address - Phone:404-931-3675
Mailing Address - Fax:
Practice Address - Street 1:814 MIMOSA BLVD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4410
Practice Address - Country:US
Practice Address - Phone:678-310-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 102L00000X
GALPC004568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst