Provider Demographics
NPI:1164029468
Name:JONES, FARRAH TYKISIA (LGPC)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:TYKISIA
Last Name:JONES
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 CROOKED PINE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3793
Mailing Address - Country:US
Mailing Address - Phone:404-909-2670
Mailing Address - Fax:
Practice Address - Street 1:14201 LAUREL PARK DR STE 106
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:240-360-4765
Practice Address - Fax:240-360-4767
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty