Provider Demographics
NPI:1164032082
Name:JONES, JEREMIAH ERIN (ASW)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:ERIN
Last Name:JONES
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W IMPERIAL HWY STE E201
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6300
Mailing Address - Country:US
Mailing Address - Phone:714-517-6140
Mailing Address - Fax:
Practice Address - Street 1:2035 E BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5159
Practice Address - Country:US
Practice Address - Phone:714-517-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108116104100000X
CA101YA0400X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker