Provider Demographics
NPI:1225698871
Name:CHASE, JEMEISHA SHAVONNE
Entity Type:Individual
Prefix:
First Name:JEMEISHA
Middle Name:SHAVONNE
Last Name:CHASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 INDEPENDENCE PKWY STE 400B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5205
Mailing Address - Country:US
Mailing Address - Phone:757-267-9634
Mailing Address - Fax:
Practice Address - Street 1:212 RIDGECREST PL
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3943
Practice Address - Country:US
Practice Address - Phone:757-338-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician