Provider Demographics
NPI:1295458289
Name:KANE-WEST, JONAH (MA)
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:
Last Name:KANE-WEST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2707
Mailing Address - Country:US
Mailing Address - Phone:434-284-2084
Mailing Address - Fax:
Practice Address - Street 1:6200 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5248
Practice Address - Country:US
Practice Address - Phone:804-307-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health