MEDICARE: MRS. JILL LEANN THOMAS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701015050	VA

General Provider Information

NPI Number	:	1215669478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL LEANN THOMAS LPC

Provider Business Mailing Address
First Line	:	116 LANDMARK SQ STE 103
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6872
Country	:	US
Telephone Number	:	757-414-7170
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 LANDMARK SQ STE 103
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6872
Country	:	US
Telephone Number	:	757-414-7170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	01/13/2026

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