Provider Demographics
NPI:1760299879
Name:DAHLBERG, JAYLA
Entity type:Individual
Prefix:
First Name:JAYLA
Middle Name:
Last Name:DAHLBERG
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 1:196 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4330
Mailing Address - Country:US
Mailing Address - Phone:757-450-0383
Mailing Address - Fax:757-296-0029
Practice Address - Street 1:196 WAVERLY DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4330
Practice Address - Country:US
Practice Address - Phone:757-450-0383
Practice Address - Fax:757-296-0029
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician