Healthcare Provider Details

I. General information

NPI: 1215447305
Provider Name (Legal Business Name): DARRELL ANTONIO JONES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 CAPE COD LN
PALMDALE CA
93550-7006
US

IV. Provider business mailing address

2006 CAPE COD LN
PALMDALE CA
93550-7006
US

V. Phone/Fax

Practice location:
  • Phone: 661-466-7956
  • Fax:
Mailing address:
  • Phone: 661-466-7956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16900
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: