MEDICARE: MRS. JAIME BETH RACER 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	101YM0800X	Mental Health Counselor	0701003856	VA

General Provider Information

NPI Number	:	1326053026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAIME BETH RACER LPC

Provider Business Mailing Address
First Line	:	12721 DARBY BROOK CT
Second Line	:	SUITE 102
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2408
Country	:	US
Telephone Number	:	703-497-1771
Fax Number	:	703-497-1225

Provider Business Practice Location Address
First Line	:	12721 DARBY BROOK CT
Second Line	:	SUITE 102
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2408
Country	:	US
Telephone Number	:	703-497-1771
Fax Number	:	703-497-1225

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/08/2007

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