1932206513 NPI number — MISS JACKIE P POLLARD LPC, LMFT, MAC,NCC

Table of content: STEPHANIE DAVIS FNP (NPI 1497362198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932206513 NPI number — MISS JACKIE P POLLARD LPC, LMFT, MAC,NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLLARD
Provider First Name:
JACKIE
Provider Middle Name:
P
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LPC, LMFT, MAC,NCC
Provider Gender Code:
F

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:
1932206513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLONIAL HEIGHTS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23834-0276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-520-1655
Provider Business Mailing Address Fax Number:
804-520-8595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 W ELLERSLIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-520-1655
Provider Business Practice Location Address Fax Number:
804-520-8595
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  0701001792 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 0717000056 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 085513 . This is a "SENTARA BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 106008 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5906567 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 184246 . This is a "UNITED HEALTH CARE/UBH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 059404 . This is a "VALUE OPTIONS NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 246353 . This is a "MHN/TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5400091 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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