Healthcare Provider Details

I. General information

NPI: 1164769352
Provider Name (Legal Business Name): JENNIFER A MIXAN-DARDEN L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 STAPLES MILL RD
RICHMOND VA
23228
US

IV. Provider business mailing address

5821 STAPLES MILL RD
RICHMOND VA
23228-5427
US

V. Phone/Fax

Practice location:
  • Phone: 804-822-9764
  • Fax: 804-264-1029
Mailing address:
  • Phone: 804-822-9764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005390
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: