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General NPI Number Information
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NPI Number | 1477909455
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Entity Type | Individual
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Provider Name | JANICE PETTY LPC, LSATP
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Gender | Female
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVE STE 701
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1306
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Country | US
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Telephone | 571-354-0338
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Fax | 571-386-2663
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Provider Business Mailing Address
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Address Line | 4660 KENMORE AVE STE 701
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1306
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Country | US
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Telephone | 571-354-0338
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Fax | 571-386-2663
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0718000324
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701006463
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 071010213
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License Number State | VA
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