Healthcare Provider Details

I. General information

NPI: 1508375858
Provider Name (Legal Business Name): JASMINE FERRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date: 12/03/2019
Reactivation Date: 02/06/2024

III. Provider practice location address

4850 MARK CENTER DR
ALEXANDRIA VA
22311-1882
US

IV. Provider business mailing address

4850 MARK CENTER DR
ALEXANDRIA VA
22311-1882
US

V. Phone/Fax

Practice location:
  • Phone: 703-746-3400
  • Fax:
Mailing address:
  • Phone: 703-746-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001899
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: