Provider Demographics
NPI:1982192480
Name:THERYON, JILLIAN ANTOINETTE (LICSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:ANTOINETTE
Last Name:THERYON
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3296
Mailing Address - Country:US
Mailing Address - Phone:860-597-6037
Mailing Address - Fax:
Practice Address - Street 1:1235 S CLARK ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3296
Practice Address - Country:US
Practice Address - Phone:202-655-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040123121041C0700X
DCLC500822561041C0700X
COCSW.099276631041C0700X
PACW0226581041C0700X
IL149.0244371041C0700X
CT0101921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical