Individual
MS. JENNIFER J MIXSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
15521 MIDLOTHIAN TPKE STE 105, MIDLOTHIAN, VA 23113-7313
(804) 207-6737
Mailing address
15521 MIDLOTHIAN TPKE STE 105, MIDLOTHIAN, VA 23113-7313
(804) 207-6737
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701006293
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30016005760002
—
VA
Enumeration date
09/25/2015
Last updated
11/28/2023
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