Provider Demographics
NPI:1265839518
Name:ELISA WELLS JONES LCSW LLC
Entity Type:Organization
Organization Name:ELISA WELLS JONES LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:251-215-9953
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:LILLIAN
Mailing Address - State:AL
Mailing Address - Zip Code:36549-0834
Mailing Address - Country:US
Mailing Address - Phone:251-215-9953
Mailing Address - Fax:
Practice Address - Street 1:11557 SORRENTO RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8617
Practice Address - Country:US
Practice Address - Phone:251-215-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELISA WELLS JONES LCSW LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7653251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health