Provider Demographics
NPI:1578035325
Name:VIJAYAN, JITHIN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JITHIN
Middle Name:
Last Name:VIJAYAN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LOOKOUT DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3812
Mailing Address - Country:US
Mailing Address - Phone:757-777-6751
Mailing Address - Fax:
Practice Address - Street 1:204 LOOKOUT DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-3812
Practice Address - Country:US
Practice Address - Phone:757-777-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP2303011OtherARKANSAS BOARD OF EXAMINERS IN COUNSELING AND MARRIAGE AND FAMILY THERAPY
VT068.0134892TELEOtherVERMONT OFFICE OF PROFESSIONAL REGULATION
PAPC010866OtherPENNSYLVANIA STATE BOARD OF SOCIAL WORKERS, MFTS AND PROFESSIONAL COUNSELORS