Provider Demographics
NPI:1922735877
Name:BURRELL, JAMAR (RESIDENT LPC)
Entity Type:Individual
Prefix:
First Name:JAMAR
Middle Name:
Last Name:BURRELL
Suffix:
Gender:M
Credentials:RESIDENT LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2611
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-0868
Mailing Address - Country:US
Mailing Address - Phone:202-780-9820
Mailing Address - Fax:
Practice Address - Street 1:1934 OLD GALLOWS RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-4042
Practice Address - Country:US
Practice Address - Phone:202-780-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional