Provider Demographics
NPI:1427672575
Name:JONES, MONIQUE T (LAPC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:T
Last Name:JONES
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 VININGS TRL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8641
Mailing Address - Country:US
Mailing Address - Phone:140-478-6002
Mailing Address - Fax:
Practice Address - Street 1:2480 WINDY HILL RD SE STE 105
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8608
Practice Address - Country:US
Practice Address - Phone:762-585-4974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006324OtherLAPC