Provider Demographics
NPI:1821740267
Name:JONES-GAINEY, MYRIA (LCSW)
Entity Type:Individual
Prefix:
First Name:MYRIA
Middle Name:
Last Name:JONES-GAINEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1763
Mailing Address - Country:US
Mailing Address - Phone:757-788-0200
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1763
Practice Address - Country:US
Practice Address - Phone:757-788-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904013608104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659424448Medicaid