Healthcare Provider Details

I. General information

NPI: 1063390433
Provider Name (Legal Business Name): JILLIAN ULERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SOUTHLAKE BLVD STE B
NORTH CHESTERFIELD VA
23236-3935
US

IV. Provider business mailing address

830 SOUTHLAKE BLVD STE B
NORTH CHESTERFIELD VA
23236-3935
US

V. Phone/Fax

Practice location:
  • Phone: 804-466-3130
  • Fax: 804-630-0665
Mailing address:
  • Phone: 804-466-3130
  • Fax: 804-630-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: