Provider Demographics
NPI:1144661935
Name:JENNINGS, JESSICA L (LPC, ADC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LPC, ADC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAPC
Mailing Address - Street 1:1103 VEGAS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3739
Mailing Address - Country:US
Mailing Address - Phone:404-579-9763
Mailing Address - Fax:434-296-0081
Practice Address - Street 1:281 INDEPENDENCE BLVD
Practice Address - Street 2:STE 326
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2986
Practice Address - Country:US
Practice Address - Phone:757-490-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004672101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)