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Individual
TARA JILL NULL
Active
Individual
TARA JILL NULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710103240
VA
101YP2500X
Professional Counselor
Primary
0701010215
VA
Other
Enumeration date
11/17/2018
Last updated
01/03/2023
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