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General NPI Number Information
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NPI Number | 1770634289
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Entity Type | Individual
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Provider Name | JENNIFER A FACTEAU LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 10500 SUMMIT AVE
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City | KENSINGTON
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State | MD
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Zip | 20895-2422
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Country | US
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Telephone | 301-897-2373
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Fax | 301-897-2373
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Provider Business Mailing Address
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Address Line | 8045 BRIGHTWOOD CT
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-7934
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Country | US
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Telephone | 443-807-3547
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Fax | 443-807-3547
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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 | LC2293
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License Number State | MD
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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 | PRC14095
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License Number State | DC
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