1912044009 NPI number — DR. JENNIFER LYNN CLINE PHD, LPC

Table of content: DR. JENNIFER LYNN CLINE PHD, LPC (NPI 1912044009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912044009 NPI number — DR. JENNIFER LYNN CLINE PHD, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLINE
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HATTER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912044009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
726 BURKETOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEYERS CAVE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24486-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-649-5570
Provider Business Mailing Address Fax Number:
540-266-3846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1181 SMITH AVENUE
Provider Second Line Business Practice Location Address:
EMU
Provider Business Practice Location Address City Name:
HARRISONBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-432-4213
Provider Business Practice Location Address Fax Number:
540-266-3846
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701003635 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 918 . This is a "APPROVED CLINICAL SUPERVISOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010092574 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0701003635 . This is a "LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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