Provider Demographics
NPI:1639938178
Name:JBAN, LLC
Entity Type:Organization
Organization Name:JBAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-447-4480
Mailing Address - Street 1:201 W TAZEWELL ST APT 307
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1319
Mailing Address - Country:US
Mailing Address - Phone:757-447-4480
Mailing Address - Fax:
Practice Address - Street 1:201 COLLEGE PL
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-0914
Practice Address - Country:US
Practice Address - Phone:757-447-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty