Healthcare Provider Details

I. General information

NPI: 1316454846
Provider Name (Legal Business Name): JENNIFER BROOKE SARVER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER BROOKE NUNN

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CLAY DR
POUNDING MILL VA
24637-4320
US

IV. Provider business mailing address

10304 SPOTSYLVANIA AVE STE 300
FREDERICKSBURG VA
22408-8605
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-3606
  • Fax:
Mailing address:
  • Phone: 540-710-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701007306
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: