person
Jasper M Boomer, LSATP
Addiction (Substance Use Disorder) Counselor in Chantilly, Virginia
NPI 1679227623

Jasper M Boomer is an Addiction (Substance Use Disorder) Counselor based in Chantilly, VA and is specialized in Addiction (Substance Use Disorder). Jasper M Boomer practices in Chantilly, VA and has the professional credentials of LSATP. The NPI Number for Jasper M Boomer is 1679227623 and holds a License No. 0718000456 (Virginia).

The current practice location address for Jasper M Boomer is 4229 Lafayette Ctr Dr Ste 1675, Chantilly, VA and can be reached out via phone at 855-326-4673.

Location: 4229 Lafayette Ctr Dr Ste 1675, Chantilly, VA, 20151-1270
person
Provider Profile Details
NPI Number
1679227623
Provider Name
Jasper M Boomer
Credential
LSATP
Provider Entity Type
Individual
Gender
Male
Address
4229 Lafayette Ctr Dr Ste 1675, Chantilly, VA, 20151-1270
Phone Number
855-326-4673
Fax Number
Provider Enumeration Date
02/08/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
4229 Lafayette Ctr Dr Ste 1675
City
State
Zip
20151-1270
Phone Number
855-326-4673
Fax Number
person
Provider Business Mailing Address Details
Address
4229 Lafayette Ctr Dr Ste 1675
City
State
Zip
20151-1270
Phone Number
855-326-4673
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
0718000456 (Virginia)
Definition
Definition to come...
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