Provider Demographics
NPI:1205076304
Name:FUENTES, JENNIFER JILL (MS NCC LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JILL
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MS NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 DEVONSHIRE PL NW UNIT I
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3479
Mailing Address - Country:US
Mailing Address - Phone:540-455-2585
Mailing Address - Fax:
Practice Address - Street 1:2737 DEVONSHIRE PL NW UNIT I
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3479
Practice Address - Country:US
Practice Address - Phone:540-455-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional