Jillian Antoinette Theryon, LICSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

010192 Issued in CT

Practice address

1235 S Clark St
Arlington, VA 22202-3296

Phone

(202) 655-7138

NPI assigned

Apr 30, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Capitolhill Consortium for Counseling & Consultation, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Washington, DC
  • NPI 1992965552
  Medicare reassignment NPD
• Ladderbox, LLC

  • Community/Behavioral Health Agency
  • Chantilly, VA
  • NPI 1063107696
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1982192480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 S CLARK ST",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222023296",
            "telephone_number": "860-597-6037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 S CLARK ST",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222023296",
            "telephone_number": "202-655-7138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7182 Main St",
            "address_purpose": "LOCATION",
            "city": "Trumbull",
            "state": "CT",
            "postal_code": "066111314",
            "country_code": "US",
            "telephone_number": "860-597-6037",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "501 W Purchase Rd Apt 1",
            "address_purpose": "LOCATION",
            "city": "Southbury",
            "state": "CT",
            "postal_code": "064881003",
            "country_code": "US",
            "telephone_number": "186-059-7603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4252 Airline Pkwy",
            "address_purpose": "LOCATION",
            "city": "Chantilly",
            "state": "VA",
            "postal_code": "201513968",
            "country_code": "US",
            "telephone_number": "860-597-6037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THERYON",
        "first_name": "JILLIAN",
        "middle_name": "ANTOINETTE",
        "name_prefix": "Ms.",
        "credential": "LICSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-30",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904012312",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50082256",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09927663",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW022658",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.024437",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "010192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Revival Reserve
• The Shift With Dr. Ellen
• The Teal Center for Therapeutic Bodywork, LTD.
• The Ultimate You, LLC
• Umera Thebo, MD
• THG Health
• Heather Haynes Thibodeau, DPT
• Pamela Ann Thielmann, LCSW
• Third Space Speech and Language Therapy PLLC
• Thomas F Lindsey DDS PC

• Clinical Social Worker in Arlington, VA
• Providers in Arlington, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.