Healthcare Provider Details

I. General information

NPI: 1154575280
Provider Name (Legal Business Name): JAYSON THOMAS BLAIR CERTIFIED LIFE COACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44110 ASHBURN SHOPPING PLZ SUITE 251
ASHBURN VA
20147-3999
US

IV. Provider business mailing address

44100 ASHBURN SHOPPING PLZ SUITE 251
ASHBURN VA
20147
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-2999
  • Fax: 703-723-4144
Mailing address:
  • Phone: 703-723-2999
  • Fax: 703-723-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: