Healthcare Provider Details

I. General information

NPI: 1538883616
Provider Name (Legal Business Name): JALISA ARIELLE JONES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 WASHINGTON HWY # A
ASHLAND VA
23005-7646
US

IV. Provider business mailing address

12300 WASHINGTON HWY # A
ASHLAND VA
23005-7646
US

V. Phone/Fax

Practice location:
  • Phone: 804-658-7696
  • Fax:
Mailing address:
  • Phone: 804-658-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701011836
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: