Provider Demographics
NPI:1356703383
Name:HUBAND, JENNIFER J (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:HUBAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PLEASURE HOUSE RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4062
Mailing Address - Country:US
Mailing Address - Phone:757-578-2985
Mailing Address - Fax:
Practice Address - Street 1:15064 CARROLLTON BLVD STE 19
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3580
Practice Address - Country:US
Practice Address - Phone:757-578-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040093711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical