Provider Demographics
NPI:1194401125
Name:JONES-EDELEN, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:JONES-EDELEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 BRINKLEY STATION DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6176
Mailing Address - Country:US
Mailing Address - Phone:202-421-7521
Mailing Address - Fax:
Practice Address - Street 1:3040 BRINKLEY STATION DR
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6176
Practice Address - Country:US
Practice Address - Phone:202-421-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health