Organization
JOTAVA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VERNON OLIVER EJD, LCSW (CEO/PRESIDENT)
(804) 247-3195
Entity
Organization
Contact information
Practice address
1607 TITANIUM AVENUE, 202, MIDLOTHIAN, VA 23114
(804) 379-7186
(804) 379-7186
Mailing address
16407 OTTERDALE POINTE DR, MOSELEY, VA 23120-1556
(804) 247-3195
(804) 739-9370
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
10/20/2020
Last updated
10/20/2020
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