Provider Demographics
NPI:1083300479
Name:NORTHOVER, JAHLIL
Entity Type:Individual
Prefix:
First Name:JAHLIL
Middle Name:
Last Name:NORTHOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 MADISON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3340
Mailing Address - Country:US
Mailing Address - Phone:540-738-7720
Mailing Address - Fax:540-779-0728
Practice Address - Street 1:767 MADISON RD STE 110
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3340
Practice Address - Country:US
Practice Address - Phone:540-738-7720
Practice Address - Fax:540-779-0728
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty