Provider Demographics
NPI:1740833672
Name:JENSEN, AMY LYDIA (LPC,CSAC,NCC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYDIA
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPC,CSAC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15629 NEATH DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1042
Mailing Address - Country:US
Mailing Address - Phone:703-282-6026
Mailing Address - Fax:
Practice Address - Street 1:15941 DONALD CURTIS DR STE 200
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4257
Practice Address - Country:US
Practice Address - Phone:703-792-4900
Practice Address - Fax:703-792-5699
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional