Provider Demographics
NPI:1477617108
Name:HAGEN, JILL ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANN
Last Name:HAGEN
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 1:2 PIDGEON HILL DR STE 450
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6148
Mailing Address - Country:US
Mailing Address - Phone:703-433-1553
Mailing Address - Fax:703-480-9433
Practice Address - Street 1:2 PIDGEON HILL DR STE 450
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6148
Practice Address - Country:US
Practice Address - Phone:703-433-1553
Practice Address - Fax:703-480-9433
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945247Medicaid