Organization
DIANA JAMISON LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA JAMISON MSW LCSW (MEMBER MANAGER)
(804) 436-9218
Entity
Organization
Contact information
Practice address
25 OFFICE PARK DRIVE, KILMARNOCK, VA 22482-0877
(804) 436-9218
(804) 435-6836
Mailing address
PO BOX 877, KILMARNOCK, VA 22482-0877
(804) 436-9218
(804) 435-6836
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
0904000993
VA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
0904000993
VA
Other
Enumeration date
05/19/2008
Last updated
05/19/2008
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