Provider Demographics
NPI:1194164574
Name:PERSINGER, JACEY
Entity type:Individual
Prefix:
First Name:JACEY
Middle Name:
Last Name:PERSINGER
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 1:1021 EDEN WAY N,
Mailing Address - Street 2:STE 118 PMB 373
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2766
Mailing Address - Country:US
Mailing Address - Phone:757-863-3412
Mailing Address - Fax:757-432-3139
Practice Address - Street 1:1021 EDEN WAY N,
Practice Address - Street 2:STE 118 PMB 373
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2766
Practice Address - Country:US
Practice Address - Phone:757-863-3412
Practice Address - Fax:757-432-3139
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health