Provider Demographics
NPI:1255959029
Name:JOLLEY, JESSICA (MED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HOFMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, LBA
Mailing Address - Street 1:4100 PRICE CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3379
Mailing Address - Country:US
Mailing Address - Phone:303-335-8088
Mailing Address - Fax:
Practice Address - Street 1:4100 PRICE CLUB BLVD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3379
Practice Address - Country:US
Practice Address - Phone:303-335-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA1-20-42180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst