Individual
ELLEN A JETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9702 GAYTON RD, #181, RICHMOND, VA 23238-4907
(804) 741-7500
(804) 741-7900
Mailing address
9702 GAYTON RD, #181, RICHMOND, VA 23238-4907
(804) 741-7500
(804) 741-7900
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904003824
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0904003824
0904003824
VA
Enumeration date
06/12/2009
Last updated
06/12/2009
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