Individual
JASPER M BOOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSATP
Contact information
Practice address
4229 LAFAYETTE CTR DR STE 1675, CHANTILLY, VA 20151-1270
(855) 326-4673
Mailing address
4229 LAFAYETTE CTR DR STE 1675, CHANTILLY, VA 20151-1270
(855) 326-4673
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0718000456
VA
Other
Enumeration date
02/08/2022
Last updated
02/08/2022
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