Healthcare Provider Details

I. General information

NPI: 1528576121
Provider Name (Legal Business Name): JORDAN ROCHELLE EMMINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 SHAWNEE RD STE 101
ALEXANDRIA VA
22312-2377
US

IV. Provider business mailing address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

V. Phone/Fax

Practice location:
  • Phone: 855-935-3691
  • Fax:
Mailing address:
  • Phone: 888-344-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00004260
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-62946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: