Provider Demographics
NPI:1194150441
Name:PAYNE, JESSICA STARRING (QMHP, BCABA, LABA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:STARRING
Last Name:PAYNE
Suffix:
Gender:
Credentials:QMHP, BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 PORTERS MILL CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-1250
Mailing Address - Country:US
Mailing Address - Phone:804-402-8395
Mailing Address - Fax:804-378-6183
Practice Address - Street 1:11311 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3199
Practice Address - Country:US
Practice Address - Phone:804-378-6141
Practice Address - Fax:804-378-6183
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000096106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst