Provider Demographics
NPI:1891139812
Name:JENSEN, MELINDA MECHAM
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MECHAM
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LEE HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1047
Mailing Address - Country:US
Mailing Address - Phone:703-739-2614
Mailing Address - Fax:
Practice Address - Street 1:1501 LEE HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-1047
Practice Address - Country:US
Practice Address - Phone:703-739-2614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional