Provider Demographics
NPI:1568187193
Name:HANNA, MEADE JONES (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MEADE
Middle Name:JONES
Last Name:HANNA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:MEADE
Other - Middle Name:MOUNTCASTLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHP-A
Mailing Address - Street 1:4410 SHIRLEY GATE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5518
Mailing Address - Country:US
Mailing Address - Phone:703-205-9452
Mailing Address - Fax:
Practice Address - Street 1:4410 SHIRLEY GATE RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5518
Practice Address - Country:US
Practice Address - Phone:703-205-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904013888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health