Individual
JENNIFER L CICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
102 HERITAGE WAY NE, SUITE 302, LEESBURG, VA 20176-4544
(703) 771-5625
Mailing address
102 HERITAGE WAY NE, SUITE 302, LEESBURG, VA 20176-4544
(703) 771-5625
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005578
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101861
ANTHEM
VA
01
—
101862
ANTHEM
VA
01
—
293877
AMERIGROUP
VA
01
—
540948306
TRICARE
VA
Enumeration date
08/29/2006
Last updated
05/07/2015
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