Provider Demographics
NPI:1053501197
Name:JONES, CARMEN P
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:P
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 1:10567 NE SUNRISE BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4518
Mailing Address - Country:US
Mailing Address - Phone:509-944-0545
Mailing Address - Fax:
Practice Address - Street 1:10567 NE SUNRISE BLUFF LN
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-4518
Practice Address - Country:US
Practice Address - Phone:509-944-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC58303101Y00000X
WALH 60637457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC58303OtherWASHINGTON COUNSELOR REGI