Provider Demographics
NPI:1659512242
Name:JAMISON, JAMES STARRETT (MA, NCSP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STARRETT
Last Name:JAMISON
Suffix:
Gender:M
Credentials:MA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:TROUTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24175-6671
Mailing Address - Country:US
Mailing Address - Phone:540-397-3429
Mailing Address - Fax:540-977-6127
Practice Address - Street 1:32 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:TROUTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24175-6671
Practice Address - Country:US
Practice Address - Phone:540-397-3429
Practice Address - Fax:540-977-6127
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002797101YP2500X
FL000500103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool