Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0810004602 | VA |
NPI | 1114211893 |
---|---|
Provider Name | Jennifer Blair Beard |
First Address | Charlottesville, VA 22908-0760 |
Second Address | Charlottesville, VA 22908-0760 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 18/09/2012 |