MEDICARE: CARLAN JONES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904015981	VA
2	1041C0700X	Clinical Social Worker	124074	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0904015981	OTHER	VA	LICENSE NUMBER
2	124074	OTHER	CA	ASWB
3	1508605940	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1710752027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLAN JONES LCSW

Provider Business Mailing Address
First Line	:	2380 LIBERTY WAY STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3466
Country	:	US
Telephone Number	:	757-354-1051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2380 LIBERTY WAY STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3466
Country	:	US
Telephone Number	:	757-354-1051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2023
Last Update Date	:	03/07/2025

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Directions to “ CARLAN JONES LCSW” Practice Location

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