Provider Demographics
NPI:1104140573
Name:JONES, JANE CONSTANCE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:CONSTANCE
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GLENDALOUGH CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2942
Mailing Address - Country:US
Mailing Address - Phone:770-683-9375
Mailing Address - Fax:678-868-2354
Practice Address - Street 1:100 GLENDALOUGH CT
Practice Address - Street 2:SUITE E
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2942
Practice Address - Country:US
Practice Address - Phone:770-683-9375
Practice Address - Fax:678-868-2354
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002402101YP2500X
GALPC006520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional