Provider Demographics
NPI:1316323520
Name:SCHLADT, JESSICA ELLIN (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELLIN
Last Name:SCHLADT
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELLIN
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6130 OLD BRENTFORD CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-4344
Mailing Address - Country:US
Mailing Address - Phone:703-582-2669
Mailing Address - Fax:
Practice Address - Street 1:13525 LELAND RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-2037
Practice Address - Country:US
Practice Address - Phone:703-222-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional