Provider Demographics
NPI:1124632112
Name:COTTREAU, JENA SHANE (LGPC, NCC)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:SHANE
Last Name:COTTREAU
Suffix:
Gender:F
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 OLD DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1014
Mailing Address - Country:US
Mailing Address - Phone:404-483-3298
Mailing Address - Fax:
Practice Address - Street 1:10000 COLESVILLE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2335
Practice Address - Country:US
Practice Address - Phone:404-483-3298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10751101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor