Provider Demographics
NPI:1013676089
Name:EASON, BILLY JERMAINE
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JERMAINE
Last Name:EASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 AMERICAN LEGION RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5653
Mailing Address - Country:US
Mailing Address - Phone:757-575-1482
Mailing Address - Fax:757-282-2421
Practice Address - Street 1:3105 AMERICAN LEGION RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5653
Practice Address - Country:US
Practice Address - Phone:757-575-1482
Practice Address - Fax:757-282-2421
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-173183106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician