Provider Demographics
NPI:1568962215
Name:GIANELLO, JENIFER RUTTER (LPC)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:RUTTER
Last Name:GIANELLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:LYNN
Other - Last Name:RUTTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2120 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5718
Mailing Address - Country:US
Mailing Address - Phone:703-228-5150
Mailing Address - Fax:
Practice Address - Street 1:2120 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5718
Practice Address - Country:US
Practice Address - Phone:703-228-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional