Provider Demographics
NPI:1134586332
Name:JONES, LILLIAN BOOKER
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:BOOKER
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LILLIAN
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8421 BINK PL
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1444
Mailing Address - Country:US
Mailing Address - Phone:804-878-0620
Mailing Address - Fax:
Practice Address - Street 1:8421 BINK PL
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1444
Practice Address - Country:US
Practice Address - Phone:804-878-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS5962453171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS5962453OtherSTATE CORPORATION COMMISSION