Provider Demographics
NPI:1396136925
Name:JONES BENNETT, SHONA M (LPC, NCC, MED, MS)
Entity type:Individual
Prefix:
First Name:SHONA
Middle Name:M
Last Name:JONES BENNETT
Suffix:
Gender:F
Credentials:LPC, NCC, MED, MS
Other - Prefix:
Other - First Name:SHONA
Other - Middle Name:
Other - Last Name:JONES BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPCS, CAMSII, GCSC
Mailing Address - Street 1:PO BOX 2036
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-2036
Mailing Address - Country:US
Mailing Address - Phone:229-392-4457
Mailing Address - Fax:229-382-8353
Practice Address - Street 1:1216 DAWSON RD STE 110
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3800
Practice Address - Country:US
Practice Address - Phone:229-392-4457
Practice Address - Fax:229-382-8353
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008251101Y00000X, 101YM0800X
GA641060101YS0200X
GA008251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA79770372OtherDUN & BRADSTREET (DUNS ID#)
GAA922342OtherAMERICAN HEALTHCARE ACADEMY (CPR AND AED CERTIFICATION)
GA003157272AMedicaid
GA13509476OtherCAQH PROVIEW PROVIDER REGISTRY (CAQH PROVIDER #)
NCC668043OtherNATIONAL BOARD OF CERTIFIED COUNSELORS (NCC CERTIFICATION)
GA1835OtherHIGH IMPACT TRAINING AND COUNSELING, INC. (CAMS-II CERTIFICATION)
GA6426956OtherAMERICAN COUNSELING ASSOCIATION (ACA)
GA2079OtherLPCAGA (CERTIFIED PROFESSIONAL COUNSELOR SUPERVISOR - CPCS)
GA30967662OtherTHE LICENSED PROFESSIONAL COUNSELORS ASSOCIATION OF GEORGIA (LPCAGA)
GA641060OtherGEORGIA PROFESSIONAL STANDARDS COMMISSION (CERT. EDUCATOR IN SCHOOL COUNSELING)
GALPC008251OtherGEORGIA COMPOSITE BOARD OF PROFESSIONAL COUNSELORS, SWS, MFTS (LPC LICENSE)
GA020720170OtherTHE JOHN PRAED FOUNDATION (ANSA CERTIFICATION)