Healthcare Provider Details

I. General information

NPI: 1700454683
Provider Name (Legal Business Name): ILIANA M JONES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7969 ASHTON AVE
MANASSAS VA
20109-2885
US

IV. Provider business mailing address

4029 BENTON ST NW APT 304
WASHINGTON DC
20007-1600
US

V. Phone/Fax

Practice location:
  • Phone: 703-792-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: