Provider Demographics
NPI:1760134712
Name:JONES, KIMBERLY ANTONIETT (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANTONIETT
Last Name:JONES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14800 POTOMAC BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4056
Mailing Address - Country:US
Mailing Address - Phone:706-329-7213
Mailing Address - Fax:
Practice Address - Street 1:14800 POTOMAC BRANCH DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4056
Practice Address - Country:US
Practice Address - Phone:706-329-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0-22-13420106E00000X
18-74133106S00000X
VA1-22-63101103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty