Provider Demographics
NPI:1104690270
Name:JARRELLS, THERESA ANN
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:JARRELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WILLOW LAWN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3429
Mailing Address - Country:US
Mailing Address - Phone:804-874-9693
Mailing Address - Fax:866-829-5718
Practice Address - Street 1:500 BAPTIST DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-5781
Practice Address - Country:US
Practice Address - Phone:804-926-6390
Practice Address - Fax:866-829-5718
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist