1396233730 NPI number — CPJ COUNSELING SERVICES LLC

Table of content: JEFFEY JACOB PHYSICIAN ASSISTANT (NPI 1609159227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396233730 NPI number — CPJ COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPJ COUNSELING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396233730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3402 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23222-2913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-230-4554
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2832 COPPERSMITH PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYANS ROAD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-322-7185
Provider Business Practice Location Address Fax Number:
804-884-3855
Provider Enumeration Date:
04/30/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NORFLEET
Authorized Official First Name:
JETTIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ CLINICIAN
Authorized Official Telephone Number:
202-230-4554

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701006947 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)