Provider Demographics
NPI:1295075042
Name:FLETCHER, JAMAL R (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMAL
Middle Name:R
Last Name:FLETCHER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3162 PATRICK HENRY DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1825
Mailing Address - Country:US
Mailing Address - Phone:562-371-5144
Mailing Address - Fax:
Practice Address - Street 1:3162 PATRICK HENRY DR
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1825
Practice Address - Country:US
Practice Address - Phone:562-371-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
HILCSW-50461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health