Provider Demographics
NPI:1417287798
Name:JONES, TINA MARIA (CSAC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIA
Last Name:JONES
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4614
Mailing Address - Country:US
Mailing Address - Phone:757-849-9023
Mailing Address - Fax:757-244-1211
Practice Address - Street 1:718 23RD ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4614
Practice Address - Country:US
Practice Address - Phone:757-849-9023
Practice Address - Fax:757-244-1211
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)