MEDICARE: JAY A. MAYNARD L.P.C.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710000108	VA
2	101YP2500X	Professional Counselor	0701000921	VA

General Provider Information

NPI Number	:	1740402551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY A. MAYNARD L.P.C.

Provider Business Mailing Address
First Line	:	2501 CHERRYTREE LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-2923
Country	:	US
Telephone Number	:	804-909-3877
Fax Number	:	804-320-8738

Provider Business Practice Location Address
First Line	:	6962 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1606
Country	:	US
Telephone Number	:	804-320-7738
Fax Number	:	804-320-8738

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	09/11/2025

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