Provider Demographics
NPI:1326734468
Name:MCLEOD, JENELLE LYNETTE
Entity Type:Individual
Prefix:MS
First Name:JENELLE
Middle Name:LYNETTE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COLONIAL BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:22443-1601
Mailing Address - Country:US
Mailing Address - Phone:732-427-6450
Mailing Address - Fax:
Practice Address - Street 1:7374 CREIGHTON PKWY
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4615
Practice Address - Country:US
Practice Address - Phone:804-410-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health