Provider Demographics
NPI:1346665254
Name:BOHNENKAMP, JESSIE (LPC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:BOHNENKAMP
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 1:1106 HOMERIC ST SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5126
Mailing Address - Country:US
Mailing Address - Phone:504-330-6596
Mailing Address - Fax:
Practice Address - Street 1:44135 WOODRIDGE PKWY STE 260
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1244
Practice Address - Country:US
Practice Address - Phone:504-330-6596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5860101YP2500X
VA0701008265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional