Provider Demographics
NPI:1831794882
Name:JEMMOTT, JESSICA C (MA, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:JEMMOTT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44715 PRENTICE DR PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20101-0001
Mailing Address - Country:US
Mailing Address - Phone:703-345-4018
Mailing Address - Fax:
Practice Address - Street 1:16178 RAPTOR CREST LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5794
Practice Address - Country:US
Practice Address - Phone:610-470-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional