Healthcare Provider Details

I. General information

NPI: 1447178942
Provider Name (Legal Business Name): MIRANDA L JONES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14011 WORTH AVE
WOODBRIDGE VA
22192-4123
US

IV. Provider business mailing address

2413 DREXEL ST
LAKE RIDGE VA
22192-3526
US

V. Phone/Fax

Practice location:
  • Phone: 571-673-6735
  • Fax:
Mailing address:
  • Phone: 703-969-5308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704013830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: