Individual
JERISSA RAQUEL GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3105 AMERICAN LEGION RD STE A, CHESAPEAKE, VA 23321-5653
(757) 575-1482
(757) 282-2421
Mailing address
3105 AMERICAN LEGION RD STE A, CHESAPEAKE, VA 23321-5653
(757) 575-1482
(757) 282-2421
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-193827
VA
Other
Enumeration date
12/15/2021
Last updated
12/15/2021
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