Provider Demographics
NPI:1043357973
Name:JONES, KEITH J (LISW-CP)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:JONES
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 TRENHOLM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-3371
Mailing Address - Country:US
Mailing Address - Phone:803-787-2306
Mailing Address - Fax:803-790-6554
Practice Address - Street 1:3201 TRENHOLM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3371
Practice Address - Country:US
Practice Address - Phone:803-787-2306
Practice Address - Fax:803-790-6554
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical