Provider Demographics
NPI:1083973275
Name:JARRETT, MARISSA ELIZABETH (PSYD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELIZABETH
Last Name:JARRETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15521 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-7312
Mailing Address - Country:US
Mailing Address - Phone:804-423-1550
Mailing Address - Fax:
Practice Address - Street 1:9097 ATLEE STATION RD
Practice Address - Street 2:SUITE 219
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2525
Practice Address - Country:US
Practice Address - Phone:804-730-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004503103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical