Provider Demographics
NPI:1477102622
Name:JONES, ATHENA B
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:B
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:B
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1147 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2113
Mailing Address - Country:US
Mailing Address - Phone:707-616-7486
Mailing Address - Fax:
Practice Address - Street 1:1147 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2113
Practice Address - Country:US
Practice Address - Phone:530-222-7213
Practice Address - Fax:530-222-7268
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAR1323290918101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)