Provider Demographics
NPI:1245882273
Name:JONES, CHARLISE TERESA (LPC, LSATP)
Entity type:Individual
Prefix:
First Name:CHARLISE
Middle Name:TERESA
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:CHARLISE
Other - Middle Name:TERESA
Other - Last Name:PRESTWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LSATP
Mailing Address - Street 1:7400 SUNSWYCK CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7848
Mailing Address - Country:US
Mailing Address - Phone:804-201-3739
Mailing Address - Fax:804-566-3505
Practice Address - Street 1:7846 FOREST HILL AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1931
Practice Address - Country:US
Practice Address - Phone:804-201-3739
Practice Address - Fax:804-566-3505
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000673101YA0400X
VA0701013441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017809290001Medicaid
VA30017809290002Medicaid