Provider Demographics
NPI:1639672611
Name:JONES, MARY CATHERINE TAYLOR (EDS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MARY CATHERINE
Middle Name:TAYLOR
Last Name:JONES
Suffix:
Gender:F
Credentials:EDS, BCBA, LBA
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 553
Mailing Address - Street 2:
Mailing Address - City:CALLAO
Mailing Address - State:VA
Mailing Address - Zip Code:22435-0553
Mailing Address - Country:US
Mailing Address - Phone:804-761-9164
Mailing Address - Fax:
Practice Address - Street 1:111 BULIFANTS BLVD STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5711
Practice Address - Country:US
Practice Address - Phone:757-645-3860
Practice Address - Fax:757-645-3873
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-17-27918103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst