Provider Demographics
NPI:1225339153
Name:PRICE, JENNIFER MILLS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MILLS
Last Name:PRICE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 VIRGINIA ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-3011
Mailing Address - Country:US
Mailing Address - Phone:800-983-2875
Mailing Address - Fax:800-983-2875
Practice Address - Street 1:1335 VIRGINIA ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-3011
Practice Address - Country:US
Practice Address - Phone:800-983-2875
Practice Address - Fax:800-983-2875
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1064103T00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic