Healthcare Provider Details

I. General information

NPI: 1740402551
Provider Name (Legal Business Name): JAY A. MAYNARD L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6962 FOREST HILL AVE
RICHMOND VA
23225-1606
US

IV. Provider business mailing address

2501 CHERRYTREE LN
RICHMOND VA
23235-2923
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-7738
  • Fax: 804-320-8738
Mailing address:
  • Phone: 804-909-3877
  • Fax: 804-320-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710000108
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701000921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: