Provider Demographics
NPI:1649944158
Name:DAVIS, JENNIFER RUTH (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RUTH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9344 ADWELL RD
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-6512
Mailing Address - Country:US
Mailing Address - Phone:276-298-5034
Mailing Address - Fax:
Practice Address - Street 1:9344 ADWELL RD
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-6512
Practice Address - Country:US
Practice Address - Phone:276-221-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional