Provider Demographics
NPI:1346798527
Name:JONES, JOHN THEODORE
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THEODORE
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 BELCREST RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2011
Mailing Address - Country:US
Mailing Address - Phone:301-209-5156
Mailing Address - Fax:301-909-6009
Practice Address - Street 1:6505 BELCREST RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2011
Practice Address - Country:US
Practice Address - Phone:301-209-5156
Practice Address - Fax:301-909-6009
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25407101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)