Provider Demographics
NPI:1699123745
Name:RALSTEN, JENNIFER VICTORIA (MA, LCSW, RPT-S)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:VICTORIA
Last Name:RALSTEN
Suffix:
Gender:F
Credentials:MA, LCSW, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10549 GREGLYNN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1702
Mailing Address - Country:US
Mailing Address - Phone:804-362-7636
Mailing Address - Fax:
Practice Address - Street 1:707 N COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4045
Practice Address - Country:US
Practice Address - Phone:804-924-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA09040094621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical