Provider Demographics
NPI:1013618735
Name:MACHADO, JESSICA (MA, CAGS, NCSP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:MA, CAGS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 TOLL HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4630
Mailing Address - Country:US
Mailing Address - Phone:703-624-3968
Mailing Address - Fax:
Practice Address - Street 1:9645 BURKE LAKE RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3005
Practice Address - Country:US
Practice Address - Phone:703-426-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool