Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701004748 | VA |
NPI | 1003148800 |
---|---|
Provider Name | Jennifer Cassidy |
First Address | Berryville, VA 22611 |
Second Address | Winchester, VA 22601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2010 |
Last Update Date | 03/02/2010 |