Provider Demographics
NPI:1235216474
Name:JONES, EMMETT LEON JR (PHD LICENSED CLINICA)
Entity Type:Individual
Prefix:MR
First Name:EMMETT
Middle Name:LEON
Last Name:JONES
Suffix:JR
Gender:M
Credentials:PHD LICENSED CLINICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 73132
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-307-7014
Mailing Address - Fax:804-639-5651
Practice Address - Street 1:1811 HUGUENOT ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-307-7014
Practice Address - Fax:804-639-5651
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002890103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical