Provider Demographics
NPI:1154124980
Name:MCCORMICK, JENNA M (MSW, SUPERVISEE)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:MCCORMICK
Suffix:
Gender:
Credentials:MSW, SUPERVISEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GEORGE WASHINGTON HWY N STE 2
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1852
Mailing Address - Country:US
Mailing Address - Phone:757-773-6130
Mailing Address - Fax:757-800-3274
Practice Address - Street 1:308 GEORGE WASHINGTON HWY N STE 2
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-1852
Practice Address - Country:US
Practice Address - Phone:757-773-6130
Practice Address - Fax:757-800-3274
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906013042390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program