Jennifer Gardner, LPC, NCC – Counselor

Key facts

NPI: 1649045907
Entity type: Individual (NPI type 1)
Primary specialty: Counselor 101Y00000X
License: 0701012660 (VA)
Practice address: 8125 Parkdale CT
Springfield, VA 22153-3603
Phone: (703) 864-2005
NPI assigned: Nov 16, 2023
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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

Affect Therapeutics Inc Substance Use Disorder Rehabilitation Clinic/Center · Charlottesville, VA · NPI 1104402064

Medicare reassignment NPD DC

Medicare participation

Medicare fee-for-service enrollment: Enrolled in DC
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20241015000125	DC	Practitioner - Mental Health Counselor	4284166398	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
0701012660	VA	MD	Counselor

Practice roles

Organization	Specialty	Status	New patients
Affect Therapeutics Inc		Current since Jul 7, 2024	Accepting new patients

Locations

127 S 1st St
Ste 205
Geneva, IL 60134
Phone (773) 412-2858

507 Richland Ave
Ste 105
Athens, OH 45701
Phone (407) 693-2666

1640 Boro Pl
Fl 4
Tysons, VA 22102
Phone (571) 440-1887

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Counselor	101Y00000X	0701012660	VA	Yes

Addresses

Primary practice location

8125 Parkdale CT
Springfield, VA 22153-3603

Mailing address

8125 Parkdale CT
Springfield, VA 22153-3603
Phone (703) 864-2005

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 16, 2023.

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1649045907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8125 PARKDALE CT",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221533603",
            "telephone_number": "703-864-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8125 PARKDALE CT",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221533603",
            "telephone_number": "703-864-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JENNIFER",
        "credential": "LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-16",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "VA",
            "license": "0701012660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, VA

All providers in Springfield, VA · Counselor in Virginia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.