Provider Demographics
NPI:1104895226
Name:JENNINGS, BRIAN PETER (LCSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PETER
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 WAKEFIELD CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4467
Mailing Address - Country:US
Mailing Address - Phone:703-309-5080
Mailing Address - Fax:
Practice Address - Street 1:11 HOPE RD
Practice Address - Street 2:#23
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7202
Practice Address - Country:US
Practice Address - Phone:540-658-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005989174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00863P35Medicare ID - Type Unspecified