Provider Demographics
NPI:1104210087
Name:JONES, TAWAINA NICOLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAWAINA
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 SUPERIOR WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3277
Mailing Address - Country:US
Mailing Address - Phone:678-899-2096
Mailing Address - Fax:
Practice Address - Street 1:4751 BEST RD
Practice Address - Street 2:SUITE 400-S
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-5615
Practice Address - Country:US
Practice Address - Phone:404-860-1283
Practice Address - Fax:404-860-1283
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional