Healthcare Provider Details

I. General information

NPI: 1962843532
Provider Name (Legal Business Name): JENNIFER KEITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 GREENHOUSE RD
LEXINGTON VA
24450-3717
US

IV. Provider business mailing address

241 GREENHOUSE RD
LEXINGTON VA
24450-3717
US

V. Phone/Fax

Practice location:
  • Phone: 540-463-3141
  • Fax: 540-462-6702
Mailing address:
  • Phone: 540-463-3141
  • Fax: 540-462-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005500
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: