Individual
MS. JESSICA LAURENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CSOTP, BCN
Contact information
Practice address
10505 JUDICIAL DR STE 100, FAIRFAX, VA 22030-5157
(703) 278-0457
(703) 385-1053
Mailing address
10505 JUDICIAL DR STE 100, FAIRFAX, VA 22030-5157
(703) 278-0457
(703) 385-1053
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0701005088
VA
101YP2500X
Professional Counselor
Primary
0701005088
VA
101YP2500X
Professional Counselor
E6353
VA
Other
Enumeration date
09/15/2021
Last updated
09/15/2021
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