Provider Demographics
NPI:1508800277
Name:JAMISON, DIANA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:L
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0877
Mailing Address - Country:US
Mailing Address - Phone:804-436-9218
Mailing Address - Fax:804-435-6836
Practice Address - Street 1:25 OFFICE PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-436-9218
Practice Address - Fax:804-435-6836
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040009931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA083330OtherOPTIMA HEALTH / SENTARA/
VA186767OtherANTHEM PROVIDER NUMBER