Healthcare Provider Details

I. General information

NPI: 1194632729
Provider Name (Legal Business Name): JESSICA MIGLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 PROSPERITY AVE # 610
FAIRFAX VA
22031-4397
US

IV. Provider business mailing address

43331 HOLLYBANK PL
CHANTILLY VA
20152-2573
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-2600
  • Fax:
Mailing address:
  • Phone: 240-468-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904018855
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: