Healthcare Provider Details

I. General information

NPI: 1154793735
Provider Name (Legal Business Name): JAMIE KANTER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 12/02/2022
Certification Date: 11/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11415 ISAAC NEWTON SQUARE SOUTH
RESTON VA
20190
US

IV. Provider business mailing address

9480 MAIN ST # 1193
FAIRFAX VA
22031-4032
US

V. Phone/Fax

Practice location:
  • Phone: 703-672-3978
  • Fax:
Mailing address:
  • Phone: 703-672-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001563
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: