Provider Demographics
NPI:1063726115
Name:JONES, MAMIE A (M H THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MAMIE
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:M H THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-4244
Mailing Address - Country:US
Mailing Address - Phone:407-297-2007
Mailing Address - Fax:407-297-2007
Practice Address - Street 1:4445 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-4244
Practice Address - Country:US
Practice Address - Phone:407-297-2007
Practice Address - Fax:407-297-2007
Is Sole Proprietor?:No
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0692101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor