Provider Demographics
NPI:1972055150
Name:SARGENT, JACLYN MICHELLE (LPC, ATR-BC, LCPAT)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MICHELLE
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LPC, ATR-BC, LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101A BACKLICK RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6080
Mailing Address - Country:US
Mailing Address - Phone:571-418-1714
Mailing Address - Fax:703-333-5023
Practice Address - Street 1:5101A BACKLICK RD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6080
Practice Address - Country:US
Practice Address - Phone:571-418-1714
Practice Address - Fax:703-333-5023
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health