Provider Demographics
NPI:1063818227
Name:JONES, REGINALD LEROY (LLMSW, CAADC- DP)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:LEROY
Last Name:JONES
Suffix:
Gender:M
Credentials:LLMSW, CAADC- DP
Other - Prefix:MR
Other - First Name:REGINALD
Other - Middle Name:LEROY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW,CAAACD-DP
Mailing Address - Street 1:15519 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1445
Mailing Address - Country:US
Mailing Address - Phone:616-466-9608
Mailing Address - Fax:
Practice Address - Street 1:13575 LESURE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3131
Practice Address - Country:US
Practice Address - Phone:313-493-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL154776101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)