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NPI Code Detail

MEDICARE: MS. JILL CHRISTINE CHANGIZI-KERR M.A., L.P.C.

MEDICARE: MS. JILL CHRISTINE CHANGIZI-KERR M.A., L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0701003058VA

General Provider Information

NPI Number : 1215402532
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JILL CHRISTINE CHANGIZI-KERR M.A., L.P.C.
Provider Business Mailing Address
First Line : DULLES PSYCHOLOGICAL SERVICES
Second Line : 21351 GENTRY DRIVE, STE. 200
City : STERLING
State : VA
Zip : 20166-8512
Country : US
Telephone Number : 703-493-0891
Fax Number : 703-421-9946
Provider Business Practice Location Address
First Line : DULLES PSYCHOLOGICAL SERVICES
Second Line : 21351 GENTRY DRIVE, STE. 200
City : STERLING
State : VA
Zip : 20166-8512
Country : US
Telephone Number : 703-493-0891
Fax Number : 703-421-9946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2018
Last Update Date : 10/13/2018

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