Provider Demographics
NPI:1346855798
Name:ALTIERI, JENNIE LEE (LGPC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:LEE
Last Name:ALTIERI
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 N VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2022
Mailing Address - Country:US
Mailing Address - Phone:571-274-5200
Mailing Address - Fax:
Practice Address - Street 1:4201 CONNECTICUT AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1162
Practice Address - Country:US
Practice Address - Phone:202-624-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional