Provider Demographics
NPI:1760925341
Name:MARTIN, JEANA CARERI (LPC)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:CARERI
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JEANA
Other - Middle Name:CHRISTINE
Other - Last Name:CARERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 WASHINGTON BLVD
Mailing Address - Street 2:FL 4; FMB
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5703
Mailing Address - Country:US
Mailing Address - Phone:703-228-1698
Mailing Address - Fax:703-228-1117
Practice Address - Street 1:2120 WASHINGTON BLVD
Practice Address - Street 2:3RD FL
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5718
Practice Address - Country:US
Practice Address - Phone:703-228-1698
Practice Address - Fax:703-228-1117
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional