Provider Demographics
NPI:1861185001
Name:DUNNAVILLE, JASMINE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARIE
Last Name:DUNNAVILLE
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 1:127 CREEK FRONT LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1652
Mailing Address - Country:US
Mailing Address - Phone:804-214-6804
Mailing Address - Fax:
Practice Address - Street 1:127 CREEK FRONT LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1652
Practice Address - Country:US
Practice Address - Phone:804-214-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040151091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical