Provider Demographics
NPI:1356167712
Name:PARKER, JENNIFER MARIE (MS, RIC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 GROVE ST
Mailing Address - Street 2:STE 145, #992
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:804-476-4769
Mailing Address - Fax:
Practice Address - Street 1:18 KIRBY CT
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:WV
Practice Address - Zip Code:25413-2300
Practice Address - Country:US
Practice Address - Phone:804-476-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health