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General NPI Number Information
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NPI Number | 1073010856
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Entity Type | Individual
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Provider Name | JENNIFER RHEA DUDLEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 221 N MONROE AVE
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City | COVINGTON
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State | VA
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Zip | 24426-1409
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Country | US
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Telephone | 540-962-5049
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Fax | 540-962-7008
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Provider Business Mailing Address
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Address Line | 53 PARK AVE
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City | CLIFTON FORGE
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State | VA
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Zip | 24422-3824
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Country | US
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Telephone | 540-968-2389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904010431
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License Number State | VA
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