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General NPI Number Information
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NPI Number | 1154870293
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Entity Type | Individual
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Provider Name | KEVIN JONES
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Gender | Male
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 10505 JUDICIAL DR STE 100B
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City | FAIRFAX
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State | VA
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Zip | 22030-5157
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Country | US
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Telephone | 313-580-5861
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Fax |
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Provider Business Mailing Address
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Address Line | 5912 9TH ST NW APT 2
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City | WASHINGTON
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State | DC
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Zip | 20011-1952
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Country | US
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Telephone | 313-580-5861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 009237
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License Number State | NY
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