Provider Demographics
NPI:1184215303
Name:LIN, JODIE (JD, CHC)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:JD, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13024 PINEY GLADE RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2955
Mailing Address - Country:US
Mailing Address - Phone:703-297-2627
Mailing Address - Fax:
Practice Address - Street 1:13024 PINEY GLADE RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2955
Practice Address - Country:US
Practice Address - Phone:703-297-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty