Organization
COLLABORATIVE PAIN MANAGEMENT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE MARIE JACQUES NP (MANAGING MEMBER)
(703) 261-6758
Entity
Organization
Contact information
Practice address
10400 EATON PL STE 312, FAIRFAX, VA 22030-2208
(703) 261-6758
(703) 995-4860
Mailing address
10400 EATON PL STE 312, FAIRFAX, VA 22030-2208
(703) 261-6758
(703) 995-4860
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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