Healthcare Provider Details

I. General information

NPI: 1659533610
Provider Name (Legal Business Name): JAMIE DUCHARME PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 PLEASURE HOUSE RD
VIRGINIA BEACH VA
23455
US

IV. Provider business mailing address

2005 PLEASURE HOUSE RD
VIRGINIA BEACH VA
23455-2709
US

V. Phone/Fax

Practice location:
  • Phone: 757-301-2248
  • Fax: 757-689-8378
Mailing address:
  • Phone: 757-301-2248
  • Fax: 757-689-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810004265
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: