Individual
ASHANTIANA WILSHENA, JEMILA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
648 INDEPENDENCE PKWY STE 300, CHESAPEAKE, VA 23320-5208
(757) 776-0790
Mailing address
1408 QUIET CT, PORTSMOUTH, VA 23701-3618
(757) 289-9049
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
A60633323
VA
Other
Enumeration date
12/01/2019
Last updated
12/01/2019
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