Provider Demographics
NPI:1245668144
Name:TAYLOR, JESSICA MARIE (MAED, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MAED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 S GEORGE MASON DR
Mailing Address - Street 2:#1
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3440
Mailing Address - Country:US
Mailing Address - Phone:703-477-3295
Mailing Address - Fax:
Practice Address - Street 1:1503 S GEORGE MASON DR
Practice Address - Street 2:#1
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3440
Practice Address - Country:US
Practice Address - Phone:703-477-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health