Provider Demographics
NPI:1427315951
Name:COUNCIL, JEANETTE CAROL
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:CAROL
Last Name:COUNCIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:CAROL
Other - Last Name:COUNCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5109 GOLDSBORO DR
Mailing Address - Street 2:APT 12-I
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-1301
Mailing Address - Country:US
Mailing Address - Phone:757-232-2810
Mailing Address - Fax:
Practice Address - Street 1:5109 GOLDSBORO DR
Practice Address - Street 2:APT 12-I
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-1301
Practice Address - Country:US
Practice Address - Phone:757-232-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2012-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT23955861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst