Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0810003282 | VA |
N | 103T00000X | Psychologist | 0810003282 | VA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0810003282 | VA |
Y | 103G00000X | Clinical Psychologist | 0810003282 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003282 | VA |
N | 103TP2701X | Group Psychotherapist | 0810003282 | VA |
NPI | 1063479558 |
---|---|
Provider Name | Jennifer Lynn Burden |
First Address | Salem, VA 24153-6404 |
Second Address | Salem, VA 24153-6404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 16/02/2011 |