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General NPI Number Information
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NPI Number | 1114184165
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Entity Type | Organization
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Legal Business Name | DIANA JAMISON LCSW PLLC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 25 OFFICE PARK DRIVE
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City | KILMARNOCK
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State | VA
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Zip | 22482-0877
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Country | US
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Telephone | 804-436-9218
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Fax | 804-435-6836
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Provider Business Mailing Address
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Address Line | PO BOX 877
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City | KILMARNOCK
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State | VA
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Zip | 22482-0877
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Country | US
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Telephone | 804-436-9218
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Fax | 804-435-6836
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DIANA JAMISON
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Credential | MSW LCSW
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Telephone | 804-436-9218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 0904000993
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0904000993
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License Number State | VA
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