Healthcare Provider Details

I. General information

NPI: 1346858578
Provider Name (Legal Business Name): JESSICA RUIZ LCMHC, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8614 WESTWOOD CENTER DR STE 710
VIENNA VA
22182-2451
US

IV. Provider business mailing address

1593 SPRING HILL RD STE 705
VIENNA VA
22182-2289
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15756
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013270
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: