Provider Demographics
NPI:1467939272
Name:JONES, KIARA CHANTAY
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:CHANTAY
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 1:212 W HIGHWAY 98 STE C
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1301
Mailing Address - Country:US
Mailing Address - Phone:850-705-1766
Mailing Address - Fax:
Practice Address - Street 1:212 W HIGHWAY 98 STE C
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1301
Practice Address - Country:US
Practice Address - Phone:850-705-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health