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General NPI Number Information
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NPI Number | 1609415488
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Entity Type | Organization
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Legal Business Name | JESSE PEARLSTEIN LLC
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 5821 STAPLES MILL RD
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City | HENRICO
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State | VA
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Zip | 23228-5427
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Country | US
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Telephone | 804-264-0966
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Fax |
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Provider Business Mailing Address
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Address Line | 937 BRADLEY LN
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City | RICHMOND
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State | VA
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Zip | 23225-4305
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Country | US
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Telephone | 434-906-5299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSE GRAY PEARLSTEIN
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Credential | LCSW
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Telephone | 804-404-3659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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