Individual
JERLY HENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCR
Contact information
Practice address
10721 MAIN ST STE 2400, FAIRFAX, VA 22030-6902
(703) 270-0225
Mailing address
10721 MAIN ST STE 2400, FAIRFAX, VA 22030-6902
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0704016745
VA
Other
Enumeration date
01/30/2025
Last updated
01/30/2025
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