Provider Demographics
NPI:1194018630
Name:JONES, JOHN ALLEN (LCADC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALLEN
Last Name:JONES
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8930 STANFORD BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-789-2647
Mailing Address - Fax:410-789-8364
Practice Address - Street 1:3902 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:MD
Practice Address - Zip Code:21227-2249
Practice Address - Country:US
Practice Address - Phone:410-789-2647
Practice Address - Fax:410-789-8364
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1785101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)