Provider Demographics
NPI:1093006173
Name:JONES, JONATHAN (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 WATERLOO CIR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2236
Mailing Address - Country:US
Mailing Address - Phone:770-634-4393
Mailing Address - Fax:
Practice Address - Street 1:5883 GLENRIDGE DR
Practice Address - Street 2:SUITE 170
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5339
Practice Address - Country:US
Practice Address - Phone:770-634-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002829101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional