Provider Information for 1265803589
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JEREMY ROSS LPC, CSAC
Sex: Male
NPI: 1265803589
Last Updated: 2015-10-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1265803589 | ||||||||||||
| Enumeration Date | 2015-10-13 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 58 BEACH RD HAMPTON, VA 23664-1834 United States Phone: 757-778-7470 | Fax: | ||||||||||||
| Primary Practice Address | 58 BEACH RD HAMPTON, VA 23664-1834 United States Phone: 757-778-7470 | Fax: | ||||||||||||
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