Healthcare Provider Details

I. General information

NPI: 1538022363
Provider Name (Legal Business Name): JENNIFER MICHELE SLATTERY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6862 ELM ST STE 820
MC LEAN VA
22101-3868
US

IV. Provider business mailing address

6862 ELM ST STE 820
MC LEAN VA
22101-3868
US

V. Phone/Fax

Practice location:
  • Phone: 703-261-4583
  • Fax:
Mailing address:
  • Phone: 703-261-4583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: