Provider Demographics
NPI:1376175356
Name:JONES, CHARLENA
Entity Type:Individual
Prefix:
First Name:CHARLENA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:EASTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23347-0672
Mailing Address - Country:US
Mailing Address - Phone:757-607-7753
Mailing Address - Fax:
Practice Address - Street 1:14093 JORDAN RD
Practice Address - Street 2:
Practice Address - City:MACHIPONGO
Practice Address - State:VA
Practice Address - Zip Code:23405
Practice Address - Country:US
Practice Address - Phone:757-607-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732001566101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor