Provider Demographics
NPI:1124562251
Name:JEWELL, CASSIE (MED, LPC, LSATP)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:MED, LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S VAN DORN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6901 S VAN DORN ST
Practice Address - Street 2:
Practice Address - City:KINGSTOWNE
Practice Address - State:VA
Practice Address - Zip Code:22315-3961
Practice Address - Country:US
Practice Address - Phone:703-313-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000308101YA0400X
VA0701006554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)