Provider Demographics
NPI:1528196003
Name:JONES, VIETTKA (LCSW)
Entity Type:Individual
Prefix:
First Name:VIETTKA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 EAGLE FEATHER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8433
Mailing Address - Country:US
Mailing Address - Phone:407-617-1029
Mailing Address - Fax:407-682-4405
Practice Address - Street 1:375 DOUGLAS AVE STE 2005
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3315
Practice Address - Country:US
Practice Address - Phone:407-529-5359
Practice Address - Fax:407-682-4405
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 71981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical