Healthcare Provider Details

I. General information

NPI: 1427870724
Provider Name (Legal Business Name): JESSICA CAROL PUTNAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 E DAVIS ST STE 230
CULPEPER VA
22701-3052
US

IV. Provider business mailing address

17436 SADDLE RUN
RIXEYVILLE VA
22737-3252
US

V. Phone/Fax

Practice location:
  • Phone: 540-212-9805
  • Fax:
Mailing address:
  • Phone: 571-991-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013574
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: