Individual
JAHLEEL GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3633 CHASE CT, VIRGINIA BEACH, VA 23462-6804
(757) 650-0485
(757) 650-0485
Mailing address
3633 CHASE CT, VIRGINIA BEACH, VA 23462-6804
(757) 650-0485
(757) 650-0485
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-40907
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
932220747
UNITEDHEALTHCARE
VA
Enumeration date
01/15/2018
Last updated
01/15/2018
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