Provider Demographics
NPI:1902540180
Name:LAZO-JONES, ANA (MASTERS, PPS)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:
Last Name:LAZO-JONES
Suffix:
Gender:F
Credentials:MASTERS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DOUGLAS AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-4611
Mailing Address - Country:US
Mailing Address - Phone:132-344-5903
Mailing Address - Fax:
Practice Address - Street 1:40 DOUGLAS AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-4611
Practice Address - Country:US
Practice Address - Phone:323-344-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA083001203103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool