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General NPI Number Information
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NPI Number | 1386479426
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Entity Type | Individual
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Provider Name | JENNIFER DARLENE BASS-GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 24801 RAINEY CREEK RD
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City | MC KENNEY
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State | VA
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Zip | 23872-2315
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Country | US
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Telephone | 434-294-7305
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Fax |
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Provider Business Mailing Address
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Address Line | 24801 RAINEY CREEK RD
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City | MC KENNEY
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State | VA
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Zip | 23872-2315
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Country | US
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Telephone | 434-294-7305
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State | VA
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