Healthcare Provider Details

I. General information

NPI: 1457284648
Provider Name (Legal Business Name): DESTINY CHANTE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12007 SUNRISE VALLEY DR STE 120
RESTON VA
20191-3460
US

IV. Provider business mailing address

3202 AUBURN LN
HAMPTON VA
23666-2440
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-2089
  • Fax:
Mailing address:
  • Phone: 202-441-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: