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General NPI Number Information
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NPI Number | 1225585409
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Entity Type | Individual
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Provider Name | JENNIFER GOODRICH
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Gender | Female
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 6408 GROVEDALE DR STE 103
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2596
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Country | US
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Telephone | 202-329-6078
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Fax |
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Provider Business Mailing Address
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Address Line | 8102 LEE JACKSON CIR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553-3818
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Country | US
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Telephone | 202-329-6078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701006736
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License Number State | VA
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