Provider Demographics
NPI:1982431136
Name:KENT, JASON CORY (LPC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CORY
Last Name:KENT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 WATERVALE DR
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-2703
Mailing Address - Country:US
Mailing Address - Phone:773-339-2714
Mailing Address - Fax:
Practice Address - Street 1:3595 GRAND FORKS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-5610
Practice Address - Country:US
Practice Address - Phone:434-218-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health