Basic Information
| Provider Information | |||||||||
| NPI: | 1760818967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | LPC, LCPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10560 MAIN ST PH 4 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220307182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714949033 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3025 HAMAKER CT STE 450 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032049100 | ||||||||
| FaxNumber: | 3014681862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2013 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC4631 | MD | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 0701006536 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.