Provider Demographics
NPI:1902655103
Name:VERDIER, JEROME J SR (LLM DSP)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:J
Last Name:VERDIER
Suffix:SR
Gender:M
Credentials:LLM DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 LAKE CLUB DR STE 105
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3204
Mailing Address - Country:US
Mailing Address - Phone:202-607-9458
Mailing Address - Fax:
Practice Address - Street 1:2211 LAKE CLUB DR STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3204
Practice Address - Country:US
Practice Address - Phone:614-501-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)