MEDICARE: ROSA LEE JARVIS 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	070103880	VA

General Provider Information

NPI Number	:	1952527327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA LEE JARVIS LPC

Provider Business Mailing Address
First Line	:	2983 MEDFORD DR
Second Line	:
City	:	SOUTHBRIDGE
State	:	VA
Zip	:	22026-4519
Country	:	US
Telephone Number	:	703-445-1947
Fax Number	:

Provider Business Practice Location Address
First Line	:	8110 VIRGINIA PINE CT
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23237-2203
Country	:	US
Telephone Number	:	804-743-0727
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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