Provider Demographics
NPI:1225311616
Name:JONES, KENNARD DAVID (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:KENNARD
Middle Name:DAVID
Last Name:JONES
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9346 WILDERNESS RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:VA
Mailing Address - Zip Code:24248-8821
Mailing Address - Country:US
Mailing Address - Phone:276-445-5007
Mailing Address - Fax:
Practice Address - Street 1:9346 WILDERNESS RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:VA
Practice Address - Zip Code:24248-8821
Practice Address - Country:US
Practice Address - Phone:276-445-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001587101YM0800X
VA0717000041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist