Provider Demographics
NPI:1396742680
Name:BOONE, JENNIFER L (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:BOONE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 T ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3906
Mailing Address - Country:US
Mailing Address - Phone:202-558-8220
Mailing Address - Fax:
Practice Address - Street 1:1808 T ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7126
Practice Address - Country:US
Practice Address - Phone:202-939-0939
Practice Address - Fax:202-939-0939
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCK708OtherBCBS PROVIDER NUMBER