Provider Demographics
NPI:1275353682
Name:JONES, NIKITA (MED)
Entity type:Individual
Prefix:MR
First Name:NIKITA
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 RUDDY DUCK CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-8952
Mailing Address - Country:US
Mailing Address - Phone:804-855-8882
Mailing Address - Fax:
Practice Address - Street 1:3101 FENDALL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2609
Practice Address - Country:US
Practice Address - Phone:804-780-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0604724101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool