Provider Demographics
NPI:1700956398
Name:BEHAVIORAL HEALTHCARE OF FREDERICKSBURG PLLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTHCARE OF FREDERICKSBURG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOCKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-310-0797
Mailing Address - Street 1:407 WESTWOOD OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5109
Mailing Address - Country:US
Mailing Address - Phone:540-310-0797
Mailing Address - Fax:540-310-0791
Practice Address - Street 1:407 WESTWOOD OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5109
Practice Address - Country:US
Practice Address - Phone:540-310-0797
Practice Address - Fax:540-310-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044811041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty