Healthcare Provider Details

I. General information

NPI: 1134586548
Provider Name (Legal Business Name): ANDREA L JAMISON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14321 WINTER BREEZE DR STE 198
MIDLOTHIAN VA
23113-2452
US

IV. Provider business mailing address

5665 WILSHIRE BLVD # 1164
LOS ANGELES CA
90036-3710
US

V. Phone/Fax

Practice location:
  • Phone: 424-209-2029
  • Fax:
Mailing address:
  • Phone: 424-209-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009053
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: