Healthcare Provider Details

I. General information

NPI: 1679263685
Provider Name (Legal Business Name): JEROME JONES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10102 QUINCE APPLE CT
UPPER MARLBORO MD
20772-3871
US

IV. Provider business mailing address

10102 QUINCE APPLE CT
UPPER MARLBORO MD
20772-3871
US

V. Phone/Fax

Practice location:
  • Phone: 850-294-5254
  • Fax:
Mailing address:
  • Phone: 850-294-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC16383
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC200012556
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014810
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: