Provider Demographics
NPI:1720608136
Name:CHENETTE, JORDAN DAVID (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:DAVID
Last Name:CHENETTE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E 6TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3460
Mailing Address - Country:US
Mailing Address - Phone:703-955-1370
Mailing Address - Fax:
Practice Address - Street 1:112 E 6TH ST STE 207
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3460
Practice Address - Country:US
Practice Address - Phone:703-955-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional