| Provider / Organization | NPI | Date Certified |
|---|---|---|
| CASEY L JACK | 1205426459 | 2022-10-02 |
Casey L Jack is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1205426459. Registration indicates Casey L Jack is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Behavioral Analyst (Behavioral Health & Social Service Providers, Behavioral Analyst) (Behavioral Analyst, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Behavioral Analyst, Behavioral Health & Social Service Providers) (Behavioral Health & Social Service Providers, Behavior Technician) (Behavior Technician, Behavioral Health & Social Service Providers) (Behavior Technician, )
| Entity Type | Individual |
| Provider Name | Casey L Jack |
| Practice Office Address | 780 LYNNHAVEN PKWY VIRGINIA BEACH, VA US |
| Practice Office Telephone | 7573019065 |
| Mailing Address | 335 DARBY AVE HAMPTON, VA 236631305 US |
| Business Telephone | 7573272370 |
| Code | Practice | License No State |
|---|---|---|
| 103K00000X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Behavioral Analyst Behavioral Health & Social Service Providers Behavioral Analyst Behavioral Analyst Behavioral Health/Substance Abuse/Psychiatry Behavioral Analyst Behavioral Health & Social Service Providers | 0133002731
VA |
| 106S00000X | Behavioral Health & Social Service Providers Behavior Technician Behavior Technician Behavioral Health & Social Service Providers Behavior Technician | RBT-20-123485
VA |