=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760326193
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA KIRBY SANDERS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2026
-----------------------------------------------------
Last Update Date | 04/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13885 HEDGEWOOD DR STE 245
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22193-7931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-490-0336
-----------------------------------------------------
Fax | 703-490-4525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12664 STONE LINED CIR
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-5597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-599-2417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904020181
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------