Healthcare Provider Details

I. General information

NPI: 1659913119
Provider Name (Legal Business Name): JESSICA LEEANN OKUGIC MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 RIDGEWOOD CENTER DR
WOODBRIDGE VA
22192-5348
US

IV. Provider business mailing address

2827 NOBLE FIR CT
WOODBRIDGE VA
22192-3815
US

V. Phone/Fax

Practice location:
  • Phone: 703-861-2615
  • Fax:
Mailing address:
  • Phone: 703-861-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012078
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: