Healthcare Provider Details

I. General information

NPI: 1952154957
Provider Name (Legal Business Name): JEANNETTE ANDREA MCCAIN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNIE DOYLE MCCAIN MSW, LCSW

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 MIDLOTHIAN TPKE
NORTH CHESTERFIELD VA
23235-5163
US

IV. Provider business mailing address

1019 AMBER MEADOWS PL
MIDLOTHIAN VA
23114-1295
US

V. Phone/Fax

Practice location:
  • Phone: 804-447-6382
  • Fax: 804-447-6383
Mailing address:
  • Phone: 804-397-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: