Healthcare Provider Details

I. General information

NPI: 1851883045
Provider Name (Legal Business Name): JESSICA JASMINE DOTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 08/31/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MONUMENT DR
STAFFORD VA
22554-8508
US

IV. Provider business mailing address

12 MONUMENT DR
STAFFORD VA
22554-8508
US

V. Phone/Fax

Practice location:
  • Phone: 540-383-7133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000452
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: