Provider Demographics
NPI:1306481171
Name:HORNBY, JENNIFER RUSSELL (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RUSSELL
Last Name:HORNBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:KAY
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3897 BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1911
Mailing Address - Country:US
Mailing Address - Phone:757-394-1961
Mailing Address - Fax:
Practice Address - Street 1:3897 BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1911
Practice Address - Country:US
Practice Address - Phone:757-394-1961
Practice Address - Fax:757-394-1965
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional