Provider Demographics
NPI:1326633389
Name:JONES, DIAWN KERYSTEN
Entity Type:Individual
Prefix:
First Name:DIAWN
Middle Name:KERYSTEN
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 NORTHRIDGE OVAL BLDG 11
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3256
Mailing Address - Country:US
Mailing Address - Phone:313-478-2937
Mailing Address - Fax:
Practice Address - Street 1:398 W BAGLEY RD STE 12
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1312
Practice Address - Country:US
Practice Address - Phone:440-815-2332
Practice Address - Fax:440-815-2332
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health