Provider Demographics
NPI:1528576121
Name:EMMINGER, JORDAN ROCHELLE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ROCHELLE
Last Name:EMMINGER
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 1:7611 COPPERMINE DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2668
Mailing Address - Country:US
Mailing Address - Phone:703-496-7804
Mailing Address - Fax:571-359-6784
Practice Address - Street 1:7611 COPPERMINE DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2668
Practice Address - Country:US
Practice Address - Phone:703-496-7804
Practice Address - Fax:571-359-6784
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00004260106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician