Provider Demographics
NPI:1649737875
Name:HALLAERT, JENELLE (MS, RIC)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:HALLAERT
Suffix:
Gender:F
Credentials:MS, RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 S HAYES ST APT B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2795
Mailing Address - Country:US
Mailing Address - Phone:402-619-6404
Mailing Address - Fax:
Practice Address - Street 1:825 S TAYLOR ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1461
Practice Address - Country:US
Practice Address - Phone:410-893-4600
Practice Address - Fax:443-640-4358
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704010961101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor