Provider Demographics
NPI:1124568795
Name:JONES, MICHELLE CHERI (MSW, LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHERI
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW, LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 LOBLOLLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110
Mailing Address - Country:US
Mailing Address - Phone:614-432-4988
Mailing Address - Fax:
Practice Address - Street 1:4701 OLENTANGY RIVER RD STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1939
Practice Address - Country:US
Practice Address - Phone:614-321-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.151042101YA0400X
OHS.00262591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)