Provider Demographics
NPI:1699885095
Name:WALL, JENNIFER LAUREN (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:WALL
Suffix:
Gender:F
Credentials:LPC
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Mailing Address - Street 1:21641 RIDGETOP CIR
Mailing Address - Street 2:#105
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6597
Mailing Address - Country:US
Mailing Address - Phone:571-258-3026
Mailing Address - Fax:571-258-3032
Practice Address - Street 1:102 HERITAGE WAY NE STE 302
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:703-771-5100
Practice Address - Fax:703-777-0170
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-11-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)