Provider Demographics
NPI:1578146031
Name:JONES, CANDACE (M ED)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 MONUMENT DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5533
Mailing Address - Country:US
Mailing Address - Phone:703-725-3541
Mailing Address - Fax:
Practice Address - Street 1:12110 MONUMENT DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5532
Practice Address - Country:US
Practice Address - Phone:703-725-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor