Individual
JERRON A DENNIS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6001 LAKESIDE AVE STE 36, HENRICO, VA 23228-5749
(804) 814-7375
Mailing address
6001 LAKESIDE AVE STE 36, HENRICO, VA 23228-5749
(804) 814-7375
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
03/02/2023
Last updated
02/21/2024
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