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General NPI Number Information
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NPI Number | 1629604418
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Entity Type | Individual
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Provider Name | JERRELL CAVER
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Gender | Female
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 11350 RANDOM HILLS RD STE 240
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City | FAIRFAX
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State | VA
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Zip | 22030-6044
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Country | US
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Telephone | 301-275-6182
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Fax |
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Provider Business Mailing Address
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Address Line | 6925 MARY CAROLINE CIR UNIT H
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City | ALEXANDRIA
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State | VA
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Zip | 22310-4929
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Country | US
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Telephone | 301-275-6182
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-41777
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License Number State | VA
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