Provider Demographics
NPI:1841420759
Name:J.LAWRENCE JAMIESON,PH.D.,P.C.
Entity Type:Organization
Organization Name:J.LAWRENCE JAMIESON,PH.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J. LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-691-2408
Mailing Address - Street 1:3923 OLD LEE HWY STE 63D
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2428
Mailing Address - Country:US
Mailing Address - Phone:703-691-2408
Mailing Address - Fax:703-691-2103
Practice Address - Street 1:3923 OLD LEE HWY STE 63D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2428
Practice Address - Country:US
Practice Address - Phone:703-691-2408
Practice Address - Fax:703-691-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAR39600OtherVALUE OPTIONS
VA659354OtherMEDICARE
VA069293OtherANTHEM,BCBS OF VIRGINIA
VA659354OtherMEDICARE