Healthcare Provider Details

I. General information

NPI: 1972411262
Provider Name (Legal Business Name): MRS. JASMINE MBOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10106 KRAUSE RD
CHESTERFIELD VA
23832-6572
US

IV. Provider business mailing address

6907 IPSWICH DR
NORTH CHESTERFIELD VA
23234-6307
US

V. Phone/Fax

Practice location:
  • Phone: 703-399-2197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: