Provider Demographics
NPI:1821769852
Name:POLIZZI, JENNIE PATTERSON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:PATTERSON
Last Name:POLIZZI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNIE
Other - Middle Name:MICHELLE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15812 AERIAL VIEW RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5892
Mailing Address - Country:US
Mailing Address - Phone:703-314-4448
Mailing Address - Fax:
Practice Address - Street 1:15812 AERIAL VIEW RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5892
Practice Address - Country:US
Practice Address - Phone:703-314-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701010792OtherVIRGINIA BOARD OF COUNSELING/ NBCC