Provider Demographics
NPI:1770634289
Name:FACTEAU, JENNIFER A (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:FACTEAU
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 BRIGHTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7934
Mailing Address - Country:US
Mailing Address - Phone:443-807-3547
Mailing Address - Fax:443-807-3547
Practice Address - Street 1:10500 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2422
Practice Address - Country:US
Practice Address - Phone:301-897-2373
Practice Address - Fax:301-897-2373
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2293101YP2500X
DCPRC14095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional