Provider Demographics
NPI:1639941693
Name:ELHATW, JESSICA (MS-CMHC, RC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ELHATW
Suffix:
Gender:F
Credentials:MS-CMHC, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3735
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20195-1735
Mailing Address - Country:US
Mailing Address - Phone:570-801-2116
Mailing Address - Fax:
Practice Address - Street 1:1934 OLD GALLOWS RD STE 210
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-4043
Practice Address - Country:US
Practice Address - Phone:571-587-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health