Healthcare Provider Details

I. General information

NPI: 1396780334
Provider Name (Legal Business Name): JENNIFER WOODS TUNSTALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KAY WOODS B.S.

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 POPLAR DR
PETERSBURG VA
23805-9367
US

IV. Provider business mailing address

350 POPLAR DR
PETERSBURG VA
23805-9367
US

V. Phone/Fax

Practice location:
  • Phone: 804-733-6874
  • Fax:
Mailing address:
  • Phone: 804-722-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: