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General NPI Number Information
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NPI Number | 1922117720
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Entity Type | Individual
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Provider Name | DEBRA K. JOLLY LPC
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 638 INDEPENDENCE PKWY STE 240
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5222
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Country | US
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Telephone | 757-277-4213
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Fax |
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Provider Business Mailing Address
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Address Line | 1833 MONUMENT DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8772
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Country | US
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Telephone | 815-272-0175
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-005432
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701004469
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License Number State | VA
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