Provider Demographics
NPI:1912792631
Name:TAKEMOTO-JENNINGS, RHIANNON (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:RHIANNON
Middle Name:
Last Name:TAKEMOTO-JENNINGS
Suffix:
Gender:
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 MONUMENT HILL WAY APT 8309
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8319
Mailing Address - Country:US
Mailing Address - Phone:540-293-2515
Mailing Address - Fax:
Practice Address - Street 1:5641 BURKE CENTRE PKWY STE 118
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2261
Practice Address - Country:US
Practice Address - Phone:757-797-6465
Practice Address - Fax:844-269-1569
Is Sole Proprietor?:No
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional