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NPI Code Detail

MEDICARE: JACLYN LEA LENZ

MEDICARE: JACLYN LEA LENZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor7538SC

General Provider Information

NPI Number : 1407521537
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN LEA LENZ
Provider Business Mailing Address
First Line : 1000 JEFFERSON ST STE 2C
Second Line :
City : LYNCHBURG
State : VA
Zip : 24504-1724
Country : US
Telephone Number : 855-284-7483
Fax Number : 617-807-0958
Provider Business Practice Location Address
First Line : 4975 LACROSS RD STE 351
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6530
Country : US
Telephone Number : 855-284-7483
Fax Number : 617-807-0958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2021
Last Update Date : 08/11/2021

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Directions to “ JACLYN LEA LENZ ” Practice Location

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