Healthcare Provider Details

I. General information

NPI: 1346872785
Provider Name (Legal Business Name): JESSICA CORTES M.A., LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MOGILEVER

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MARK CENTER DR
ALEXANDRIA VA
22311-1882
US

IV. Provider business mailing address

610 E DIAMOND AVE STE 100
GAITHERSBURG MD
20877-5321
US

V. Phone/Fax

Practice location:
  • Phone: 703-746-3400
  • Fax:
Mailing address:
  • Phone: 202-924-8923
  • Fax: 240-683-6586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013677
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP10142
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: