Provider Demographics
NPI:1952860116
Name:UGALDE, JONATHAN (MSED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:UGALDE
Suffix:
Gender:M
Credentials:MSED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 SANDBAG TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2577
Mailing Address - Country:US
Mailing Address - Phone:518-774-6393
Mailing Address - Fax:
Practice Address - Street 1:9023 FOREST HILL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3054
Practice Address - Country:US
Practice Address - Phone:804-476-8210
Practice Address - Fax:804-800-2423
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional