Healthcare Provider Details

I. General information

NPI: 1033928700
Provider Name (Legal Business Name): JASLYNN GILES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 SUNRISE VALLEY DR STE 100
RESTON VA
20191-3429
US

IV. Provider business mailing address

1832 KEMPSVILLE RD STE 112 #327
VIRGINIA BEACH VA
23464-6861
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014353
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: