Healthcare Provider Details

I. General information

NPI: 1346855798
Provider Name (Legal Business Name): JENNIE LEE ALTIERI LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2020
Last Update Date: 09/12/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CONNECTICUT AVE NW STE 300
WASHINGTON DC
20008-1162
US

IV. Provider business mailing address

764 N VERMONT ST
ARLINGTON VA
22203-2022
US

V. Phone/Fax

Practice location:
  • Phone: 202-624-0010
  • Fax:
Mailing address:
  • Phone: 571-274-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC00604
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: