Provider Demographics
NPI:1114639010
Name:JENNISON, VALERIE C (AMFT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:C
Last Name:JENNISON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10531 4S COMMONS DRIVE
Mailing Address - Street 2:SUITE 166, #670
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127
Mailing Address - Country:US
Mailing Address - Phone:619-838-3876
Mailing Address - Fax:
Practice Address - Street 1:18029 CALLE AMBIENTE SUITE 519
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067
Practice Address - Country:US
Practice Address - Phone:619-838-3876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT136193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist