Provider Demographics
NPI:1497714141
Name:VENABLE, JANE B (LCSW, CSAC)
Entity Type:Individual
Prefix:MISS
First Name:JANE
Middle Name:B
Last Name:VENABLE
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 MILLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4210
Mailing Address - Country:US
Mailing Address - Phone:540-815-4355
Mailing Address - Fax:
Practice Address - Street 1:1720 MILLBROOK ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4210
Practice Address - Country:US
Practice Address - Phone:540-815-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005297101Y00000X, 1041C0700X
VA0710000841101YA0400X
NCC0067551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945263Medicaid
VI802183000OtherLCSW
VI802183000OtherLCSW
VA004945263Medicaid