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1178 Road Creek Ford Rd Dugspur VA 24325-3796 | |
(276) 733-7072 | |
Not Available |
Full Name | |
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Speciality | Counselor |
Location | 1178 Road Creek Ford Rd, Dugspur, Virginia |
Authorized Official Name and Position | Lisa Ladon Jarrell (LICENSED PROFESSIONAL COUNSELOR) |
Authorized Official Contact | 2767337072 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1178 Road Creek Ford Rd Dugspur VA 24325-3796 Ph: (276) 733-7072 | 1178 Road Creek Ford Rd Dugspur VA 24325-3796 Ph: (276) 733-7072 |
NPI Number | 1306619242 |
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Provider Enumeration Date | 11/02/2023 |
Last Update Date | 12/04/2023 |
Certification Date | 12/04/2023 |
Medicare PECOS PAC ID | 2264879923 |
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Medicare Enrollment ID | O20241007001975 |
Identifier | Type | State | Issuer |
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1306619242 | NPI | - | NPPES |
Provider Name | Lisa L Jarrell |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1811426869 PECOS PAC ID: 6305282617 Enrollment ID: I20240308002559 |