Individual
MR. JESSIE ALAN BERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
2008 GENERAL BOOTH BLVD STE B, VIRGINIA BEACH, VA 23454-5910
(757) 301-2411
Mailing address
1200 KEMPSVILLE RD, NORFOLK, VA 23502-2617
(757) 403-0661
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-91373
VA
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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