Provider Demographics
NPI:1316168750
Name:JEANES, MARY B YRD (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:B YRD
Last Name:JEANES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 BROOKFIELD CORPORATE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1670
Mailing Address - Country:US
Mailing Address - Phone:703-490-5090
Mailing Address - Fax:703-490-1809
Practice Address - Street 1:12761 DARBY BROOK CT
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2405
Practice Address - Country:US
Practice Address - Phone:703-490-5090
Practice Address - Fax:703-490-1809
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040065361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical