Provider Demographics
NPI:1295143667
Name:JENNINGS, MICHELLE C (RBT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:C
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7980 AUDUBON AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3737
Mailing Address - Country:US
Mailing Address - Phone:804-873-9310
Mailing Address - Fax:
Practice Address - Street 1:223 54TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6625
Practice Address - Country:US
Practice Address - Phone:202-246-8744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 171M00000X, 172A00000X, 372500000X, 3747P1801X, 374U00000X
VARBT-23-285878103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide