Provider Demographics
NPI:1841945979
Name:BROGAN, JENNIE (LPC)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:BROGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:BROGAN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 UNIVERSITY CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-2706
Mailing Address - Country:US
Mailing Address - Phone:540-961-8388
Mailing Address - Fax:540-322-1847
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1588
Practice Address - Country:US
Practice Address - Phone:540-838-8000
Practice Address - Fax:540-904-0051
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701011225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health