Provider Demographics
NPI:1154390979
Name:JONES, JOHANNA RAE (LPC, LSATP, NCC, CAC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:RAE
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC, LSATP, NCC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ELM AVE SW
Mailing Address - Street 2:BLUE RIDGE BEHAVIORAL HEALTHCARE
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4001
Mailing Address - Country:US
Mailing Address - Phone:540-345-9841
Mailing Address - Fax:540-527-2900
Practice Address - Street 1:611 MCDOWELL AVE NW
Practice Address - Street 2:PHASES/BLUE RIDGE BEHAVIORAL HEALTHCARE
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-1225
Practice Address - Country:US
Practice Address - Phone:540-342-2086
Practice Address - Fax:540-266-9205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002962101Y00000X
VA07018000109101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)