Provider Demographics
NPI:1922758309
Name:LOPEZ-ENRIQUEZ, JESSICA CAROLINA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAROLINA
Last Name:LOPEZ-ENRIQUEZ
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6325
Mailing Address - Country:US
Mailing Address - Phone:703-439-7700
Mailing Address - Fax:
Practice Address - Street 1:3908 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-6325
Practice Address - Country:US
Practice Address - Phone:703-439-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health