MEDICARE: JAMANDA BYAM 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	0701013620	VA

General Provider Information

NPI Number	:	1447090998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMANDA BYAM LPC

Provider Business Mailing Address
First Line	:	6601 IRONGATE SQ STE A
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6077
Country	:	US
Telephone Number	:	804-573-9505
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 IRONGATE SQ STE A
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6077
Country	:	US
Telephone Number	:	804-573-9505
Fax Number	:

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

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	05/30/2024

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