Healthcare Provider Details

I. General information

NPI: 1861136434
Provider Name (Legal Business Name): JESSICA CALLAWAY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 CAPITOL LANDING RD
WILLIAMSBURG VA
23185-4348
US

IV. Provider business mailing address

921 CAPITOL LANDING RD
WILLIAMSBURG VA
23185-4348
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-4074
  • Fax:
Mailing address:
  • Phone: 757-253-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: