Individual provider Active NPI

Jessica Coulson, LPC

  • Professional Counselor
  • Fairfax, VA
National Provider Identifier
1508480880
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701008972 Issued in VA
Practice address
8221 Willow Oaks Corporate Dr
Fairfax, VA 22031-4512
Phone
(703) 559-3000
NPI assigned
Jun 3, 2020
Last updated
Dec 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0701008972 VA Primary

Addresses

Primary practice location

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031-4512

Mailing address

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031-4512
Phone (703) 559-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231227000458 DC Practitioner - Mental Health Counselor 4486004926 Reassigns benefits to 1 organization
I20250219002211 VA Practitioner - Mental Health Counselor 4486004926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8221 Willow Oaks Corporate Dr
Fairfax Falls Church Community Services Boa
Fairfax, VA 22031-4512
Phone (703) 321-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0701008972VAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfax County, Virginia CurrentSince Jan 1, 2024 Accepting new patients
Northwestern Community Services Board CurrentSince Jul 24, 2022 Accepting new patients
Northwestern Community Services Board Mental Health CurrentSince Dec 1, 2024 Accepting new patients

Locations

12011 Government Center Pkwy
Ste 836
Fairfax, VA 22035
Phone (703) 324-3360

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031
Phone (703) 289-7599

209 W Criser Rd
Front Royal, VA 22630
Phone (540) 636-2931

209 W Criser Rd
Ste 100
Front Royal, VA 22630
Phone (540) 636-2931

209 W Criser Rd
Ste 300
Front Royal, VA 22630
Phone (540) 636-4250

158 Front Royal Pike
Ste 303
Winchester, VA 22602
Phone (540) 409-5254

170 Prosperity Dr
Winchester, VA 22602
Phone (540) 667-8888

480 W Jubal Early Dr
Ste 350
Winchester, VA 22601
Phone (540) 635-4804

441 N Main St
Woodstock, VA 22664
Phone (540) 459-4946

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1508480880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8221 WILLOW OAKS CORPORATE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314512",
            "telephone_number": "703-559-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8221 WILLOW OAKS CORPORATE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314512",
            "telephone_number": "703-559-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULSON",
        "first_name": "JESSICA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-03",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701008972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.