Provider Demographics
NPI:1063851970
Name:JONES, MIKO A (LPC, NCC, MAC)
Entity Type:Individual
Prefix:
First Name:MIKO
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 SCENIC HWY S
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3115
Mailing Address - Country:US
Mailing Address - Phone:404-492-7015
Mailing Address - Fax:404-492-7017
Practice Address - Street 1:2330 SCENIC HWY S
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3115
Practice Address - Country:US
Practice Address - Phone:404-492-7015
Practice Address - Fax:404-492-7017
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003135896AMedicaid