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Organization
SEA GLASS LLC
Active
Organization
SEA GLASS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER JENKINS-BOITNOTT (OWNER)
(804) 217-2202
Entity
Organization
Contact information
Practice address
5318 PATTERSON AVE STE C, RICHMOND, VA 23226-2044
(804) 217-2202
(833) 699-4700
Mailing address
5318 PATTERSON AVE STE C, RICHMOND, VA 23226-2044
(804) 217-2202
(833) 699-4700
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073852299
—
VA
Enumeration date
08/25/2021
Last updated
08/25/2021
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