Provider Demographics
NPI:1528569225
Name:JENNINGS, EMILY KATHERINE (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHERINE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2330
Mailing Address - Country:US
Mailing Address - Phone:276-335-2243
Mailing Address - Fax:
Practice Address - Street 1:4629 CLARKS FERRY RD
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:VA
Practice Address - Zip Code:24324-2805
Practice Address - Country:US
Practice Address - Phone:540-994-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional