| Doctor Name: | MS. JENNIFER JANE MIXSON |
| NPI Number: | 1396115960 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., LPC |
| License Number: | 0701006293 |
| Business Practice Address: | 3058 River Rd W Goochland, VA - 230633202 |
| Business Phone Number: | 8045565400 |
| Business Fax Number: | 8045565403 |
| Mailing Address: | 3058 River Rd W, P O Box 189 GOOCHLAND |
| State: | VA |
| Postal Code: | 230633202 |
| Phone Number: | 8045565400 |
| Fax Number: | 8045565403 |
| NPI Enumeration Date: | 09/25/2015 |
| NPI Last Update Date: | 09/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0701006293 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |