Provider Demographics
NPI:1073010856
Name:DUDLEY, JENNIFER RHEA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RHEA
Last Name:DUDLEY
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 1:53 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:24422-3824
Mailing Address - Country:US
Mailing Address - Phone:540-968-2389
Mailing Address - Fax:
Practice Address - Street 1:221 N MONROE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1409
Practice Address - Country:US
Practice Address - Phone:540-962-5049
Practice Address - Fax:540-962-7008
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040104311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical