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NPI Code Detail

MEDICARE: JEREL LEMAR GOFORTH

MEDICARE: JEREL LEMAR GOFORTH
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1972451771
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREL LEMAR GOFORTH
Provider Business Mailing Address
First Line : 5605 LARRY AVE
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-1713
Country : US
Telephone Number : 773-733-9898
Fax Number :
Provider Business Practice Location Address
First Line : 1728 VIRGINIA BEACH BLVD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-4533
Country : US
Telephone Number : 844-909-2375
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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Directions to “ JEREL LEMAR GOFORTH ” Practice Location

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