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General NPI Number Information
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NPI Number | 1518675081
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Entity Type | Individual
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Provider Name | JENNIFER DAMON LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 707 5TH ST NE
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City | ROANOKE
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State | VA
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Zip | 24016-2123
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Country | US
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Telephone | 540-966-5808
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Fax | 540-595-9456
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Provider Business Mailing Address
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Address Line | 1538 TERRACE RD SW
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City | ROANOKE
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State | VA
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Zip | 24015-2916
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Country | US
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Telephone | 315-427-8015
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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 | 0904014545
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License Number State | VA
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