Provider Demographics
NPI:1023897972
Name:JONES, SHANA TANDRIEKA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHANA
Middle Name:TANDRIEKA
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHANA
Other - Middle Name:TANDRIEKA
Other - Last Name:MIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59 OTSEGO DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-2071
Mailing Address - Country:US
Mailing Address - Phone:757-544-3048
Mailing Address - Fax:
Practice Address - Street 1:59 OTSEGO DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-2071
Practice Address - Country:US
Practice Address - Phone:757-544-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040157611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical