Provider Demographics
NPI:1215287461
Name:ENGELKEN, JANE DELIA (LPC, LSATP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:DELIA
Last Name:ENGELKEN
Suffix:
Gender:F
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ENGELKEN
Other - Last Name:NEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC,LSATP
Mailing Address - Street 1:10513 JUDICIAL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7528
Mailing Address - Country:US
Mailing Address - Phone:703-405-9014
Mailing Address - Fax:
Practice Address - Street 1:10513 JUDICIAL DR STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7528
Practice Address - Country:US
Practice Address - Phone:703-405-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002611101YA0400X
VA0718000100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)