Healthcare Provider Details

I. General information

NPI: 1508103391
Provider Name (Legal Business Name): MRS. LAFONDRA CECILIA JARING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 10/19/2026
Certification Date: 10/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 CENTURY CT
VIRGINIA BEACH VA
23462-4303
US

IV. Provider business mailing address

495 CENTURY CT
VIRGINIA BEACH VA
23462-4303
US

V. Phone/Fax

Practice location:
  • Phone: 757-317-0600
  • Fax: 757-317-0900
Mailing address:
  • Phone: 757-317-0600
  • Fax: 757-317-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: