Provider Demographics
NPI:1144237652
Name:JENNINGS, JULIE ADAMS (PH D)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ADAMS
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-1838
Mailing Address - Country:US
Mailing Address - Phone:540-463-7601
Mailing Address - Fax:540-463-2293
Practice Address - Street 1:120 W NELSON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2036
Practice Address - Country:US
Practice Address - Phone:450-463-7601
Practice Address - Fax:540-463-2293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7732457Medicaid
VA7732457Medicaid