Provider Demographics
NPI:1346341898
Name:JONES, SANDRA ANN (MS, L,M,H,C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, L,M,H,C
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:ANN
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:3046 CICALEE LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4900 BAYOU BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2525
Practice Address - Country:US
Practice Address - Phone:850-483-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765120100Medicaid