Provider Demographics
NPI:1972830107
Name:MOUTENOT-SMALL, JESSICA JANE (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JANE
Last Name:MOUTENOT-SMALL
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JANE
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:421 PARK ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4749
Mailing Address - Country:US
Mailing Address - Phone:434-260-0348
Mailing Address - Fax:
Practice Address - Street 1:421 PARK ST STE 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4749
Practice Address - Country:US
Practice Address - Phone:434-260-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor