Provider Demographics
NPI:1326584087
Name:JONES, MICHELLE S (MSC,MSTL,BA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:JONES
Suffix:
Gender:F
Credentials:MSC,MSTL,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 RED MILL DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6647
Mailing Address - Country:US
Mailing Address - Phone:386-931-3322
Mailing Address - Fax:
Practice Address - Street 1:430 BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4616
Practice Address - Country:US
Practice Address - Phone:386-258-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 15422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health