Healthcare Provider Details

I. General information

NPI: 1710426242
Provider Name (Legal Business Name): JESSICA PEAY L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 HUNNY POT LN
GLOUCESTER VA
23061-2754
US

IV. Provider business mailing address

1657 MERRIMAC TRL
WILLIAMSBURG VA
23185-5624
US

V. Phone/Fax

Practice location:
  • Phone: 804-286-0241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: