Basic Information
| Provider Information | |||||||||
| NPI: | 1003825084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENNINGS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | LPC, LMFT, CEAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 N CENTER DR SUITE 141 | ||||||||
| Address2: | INTERSTATE CORPORATE CENTER BUILDING 11 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574660700 | ||||||||
| FaxNumber: | 7574614826 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 N CENTER DR SUITE 141 | ||||||||
| Address2: | INTERSTATE CORPORATE CENTER BUILDING 11 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574660700 | ||||||||
| FaxNumber: | 7574614826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0701000688 | VA | X | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 0717000460 | VA | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.