Healthcare Provider Details

I. General information

NPI: 1871044412
Provider Name (Legal Business Name): JENNIFER LYNN HAMBRIGHT MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 HERMITAGE ROAD
NEWPORT NEWS VA
23606-1449
US

IV. Provider business mailing address

144 HERMITAGE ROAD
NEWPORT NEWS VA
23606-1449
US

V. Phone/Fax

Practice location:
  • Phone: 334-787-3967
  • Fax: 336-458-4707
Mailing address:
  • Phone: 336-524-5623
  • Fax: 336-458-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC011902
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP011062
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011902
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: