Provider Demographics
NPI:1043902679
Name:JONES, KENNETH TYRONE JR
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:TYRONE
Last Name:JONES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROBIN HOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5857
Mailing Address - Country:US
Mailing Address - Phone:706-409-3956
Mailing Address - Fax:
Practice Address - Street 1:415 ROBIN HOOD RD NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5857
Practice Address - Country:US
Practice Address - Phone:706-409-3956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor