Most Relevant Information
Provider Data
| NPI Number: | 1003339599 |
| Provider Name: | JENNIFER M CISCO LMFT |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | MFT001566 |
Most Important Dates
| Enumeration Date: | 07/17/2017 |
| Last Updated: | 03/17/2018 |
Provider Practice Location
386 PINE ST NE
ATLANTA
GA
303082532
Practice Location Phone/Fax
| Phone: | 2517533508 |
| Fax: |
Provider Mailing Location
106 OZARK TRL
CANTON
GA
301148847
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |