Provider Demographics
NPI:1215402532
Name:CHANGIZI-KERR, JILL CHRISTINE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:CHRISTINE
Last Name:CHANGIZI-KERR
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Gender:F
Credentials:MA, LPC
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Mailing Address - Street 1:DULLES PSYCHOLOGICAL SERVICES
Mailing Address - Street 2:21351 GENTRY DRIVE, STE. 200
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8512
Mailing Address - Country:US
Mailing Address - Phone:703-493-0891
Mailing Address - Fax:703-421-9946
Practice Address - Street 1:DULLES PSYCHOLOGICAL SERVICES
Practice Address - Street 2:21351 GENTRY DRIVE, STE. 200
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8512
Practice Address - Country:US
Practice Address - Phone:703-493-0891
Practice Address - Fax:703-421-9946
Is Sole Proprietor?:No
Enumeration Date:2018-10-13
Last Update Date:2018-10-13
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701003058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional