Provider Demographics
NPI:1366645269
Name:PARRELLA, JENNIFER KATHRYN (MS, LPC, LCMHC, NC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KATHRYN
Last Name:PARRELLA
Suffix:
Gender:F
Credentials:MS, LPC, LCMHC, NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 LEATHERBACK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5865
Mailing Address - Country:US
Mailing Address - Phone:910-620-1642
Mailing Address - Fax:
Practice Address - Street 1:5000 LEATHERBACK RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5865
Practice Address - Country:US
Practice Address - Phone:910-620-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103604Medicaid