Provider Demographics
NPI:1922117720
Name:JOLLY, DEBRA K (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:K
Last Name:JOLLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 MONUMENT DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8772
Mailing Address - Country:US
Mailing Address - Phone:815-272-0175
Mailing Address - Fax:
Practice Address - Street 1:638 INDEPENDENCE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5222
Practice Address - Country:US
Practice Address - Phone:757-277-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005432101YP2500X
VA0701004469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932273OtherBLUE CROSS BLUE SHEILD