Provider Demographics
NPI:1396346664
Name:JONES, DOMINIQUE INFINITI
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:INFINITI
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 1:2324 BENSON RDG
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6523
Mailing Address - Country:US
Mailing Address - Phone:678-852-0772
Mailing Address - Fax:
Practice Address - Street 1:435 HIGHLAND AVE NE UNIT 1423
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-5315
Practice Address - Country:US
Practice Address - Phone:678-852-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008555101YP2500X
GARBT-20-142134103K00000X
GALPC014787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst