Provider Demographics
NPI:1255194916
Name:LAURENZI, JACQUELINE BRODY (LPC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BRODY
Last Name:LAURENZI
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40996 BLOSSOM GLADE DR
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5827
Mailing Address - Country:US
Mailing Address - Phone:412-491-7140
Mailing Address - Fax:
Practice Address - Street 1:8245 BOONE BLVD STE 630
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3894
Practice Address - Country:US
Practice Address - Phone:412-491-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016693101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional