MEDICARE: CHARLISE TERESA JONES LPC, LSATP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0718000673	VA
2	101YM0800X	Mental Health Counselor	0701013441	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245882273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLISE TERESA JONES LPC, LSATP

Provider Business Mailing Address
First Line	:	7400 SUNSWYCK CT
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-7848
Country	:	US
Telephone Number	:	804-201-3739
Fax Number	:	804-566-3505

Provider Business Practice Location Address
First Line	:	7846 FOREST HILL AVE STE A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1931
Country	:	US
Telephone Number	:	804-201-3739
Fax Number	:	804-566-3505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	07/08/2025

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