Provider Demographics
NPI:1871101873
Name:JIMENEZ, YETTEL SANTANA (MA,LPC)
Entity type:Individual
Prefix:
First Name:YETTEL
Middle Name:SANTANA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 WHEELER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-1646
Mailing Address - Country:US
Mailing Address - Phone:404-610-9911
Mailing Address - Fax:
Practice Address - Street 1:4645 WHEELER CREEK DR
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-1646
Practice Address - Country:US
Practice Address - Phone:404-610-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional