Provider Demographics
NPI:1982723458
Name:JONES, LEILA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:H
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 MINK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-9775
Mailing Address - Country:US
Mailing Address - Phone:301-854-0845
Mailing Address - Fax:
Practice Address - Street 1:7338 BALTIMORE AVE
Practice Address - Street 2:SUITE 207A
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3211
Practice Address - Country:US
Practice Address - Phone:301-613-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1193101YM0800X
DCPCR13759101YP2500X
MD103TS0200X
MD04347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522137144OtherAETNA
MD758302800Medicaid
MD522137144OtherAETNA
MD5855115000Medicare UPIN
MD492253Medicare UPIN
MD758302800Medicaid