Provider Demographics
NPI:1184686271
Name:HOUSE, JANAE W (LCSW)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:W
Last Name:HOUSE
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:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-0555
Mailing Address - Country:US
Mailing Address - Phone:804-794-7777
Mailing Address - Fax:804-794-7281
Practice Address - Street 1:1133 JEFFERSON GREEN CIR
Practice Address - Street 2:SUITE100
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4300
Practice Address - Country:US
Practice Address - Phone:804-751-0453
Practice Address - Fax:804-796-1997
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040011691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010005141Medicaid
VA190000808Medicare ID - Type Unspecified