Provider Demographics
NPI:1316078850
Name:SMITH, JENNIFER LEE (MASTER OF SCIENCE)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 COMMONWEALTH DR
Mailing Address - Street 2:#100
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1893
Mailing Address - Country:US
Mailing Address - Phone:434-812-4009
Mailing Address - Fax:
Practice Address - Street 1:2300 COMMONWEALTH DR
Practice Address - Street 2:#100
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1893
Practice Address - Country:US
Practice Address - Phone:434-812-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00367200101YP2500X
VA0701005400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional