Provider Demographics
NPI:1407867179
Name:EANES, JODI LEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LEE
Last Name:EANES
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 1:1942 E BEECH RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-1934
Mailing Address - Country:US
Mailing Address - Phone:703-450-5247
Mailing Address - Fax:
Practice Address - Street 1:459 CARLISLE DR STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5607
Practice Address - Country:US
Practice Address - Phone:703-424-3729
Practice Address - Fax:703-435-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health