Provider Demographics
NPI:1194339978
Name:VENGLARCIK, JESSICA MARIE (LICSW, LCSW, MSSA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:VENGLARCIK
Suffix:
Gender:F
Credentials:LICSW, LCSW, MSSA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, LCSW
Mailing Address - Street 1:PO BOX 16038
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-8038
Mailing Address - Country:US
Mailing Address - Phone:703-879-4441
Mailing Address - Fax:703-574-2240
Practice Address - Street 1:3846 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1906
Practice Address - Country:US
Practice Address - Phone:703-879-4441
Practice Address - Fax:703-574-2240
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500787611041C0700X
VA09040090091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical