Individual
JANICE PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LSATP
Contact information
Practice address
4660 KENMORE AVE STE 701, ALEXANDRIA, VA 22304-1306
(571) 354-0338
(571) 386-2663
Mailing address
4660 KENMORE AVE STE 701, ALEXANDRIA, VA 22304-1306
(571) 354-0338
(571) 386-2663
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
071010213
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
0718000324
VA
101YP2500X
Professional Counselor
Primary
0701006463
VA
Other
Enumeration date
05/10/2016
Last updated
01/03/2020
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