Provider Demographics
NPI:1255188231
Name:LIGHT, JONDA D (LCSW)
Entity type:Individual
Prefix:
First Name:JONDA
Middle Name:D
Last Name:LIGHT
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 1:2002 BREMO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2441
Mailing Address - Country:US
Mailing Address - Phone:804-496-1488
Mailing Address - Fax:
Practice Address - Street 1:2002 BREMO RD STE 110
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2441
Practice Address - Country:US
Practice Address - Phone:804-496-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040166501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical