Provider Demographics
NPI:1336858356
Name:JONES, KANEISHA LATRIS
Entity type:Individual
Prefix:
First Name:KANEISHA
Middle Name:LATRIS
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 JONES FERRY RD APT VV02
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2198
Mailing Address - Country:US
Mailing Address - Phone:470-246-0735
Mailing Address - Fax:
Practice Address - Street 1:605 JONES FERRY RD APT VV02
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2198
Practice Address - Country:US
Practice Address - Phone:470-246-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician