Provider Demographics
NPI:1184196222
Name:JONES, BRIAN MONTRELL (LPC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MONTRELL
Last Name:JONES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NAVAJO TRL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2429
Mailing Address - Country:US
Mailing Address - Phone:803-290-3060
Mailing Address - Fax:
Practice Address - Street 1:2204 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6602
Practice Address - Country:US
Practice Address - Phone:757-644-3989
Practice Address - Fax:866-813-7798
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013158963Medicaid