Provider Demographics
NPI:1033649280
Name:JAEGER, EMMA FREDETTE (LPC)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:FREDETTE
Last Name:JAEGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 TOWNE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3173
Mailing Address - Country:US
Mailing Address - Phone:304-685-6930
Mailing Address - Fax:
Practice Address - Street 1:1975 ELK HILL RD
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3318
Practice Address - Country:US
Practice Address - Phone:434-270-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health