MEDICARE: DAVITTA JONES

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	101YP2500X	Professional Counselor	LGP15864	MD

General Provider Information

NPI Number	:	1790500437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVITTA JONES

Provider Business Mailing Address
First Line	:	12530 FAIRWOOD PKWY STE 1021251
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-6356
Country	:	US
Telephone Number	:	301-818-3909
Fax Number	:

Provider Business Practice Location Address
First Line	:	12530 FAIRWOOD PKWY STE 1021251
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-6356
Country	:	US
Telephone Number	:	301-818-3909
Fax Number	:

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

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	09/17/2025

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