Provider Demographics
NPI:1558757849
Name:JONES, ELYCIA JOY
Entity Type:Individual
Prefix:
First Name:ELYCIA
Middle Name:JOY
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 1:7917 OSTROW ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3604
Mailing Address - Country:US
Mailing Address - Phone:858-300-8282
Mailing Address - Fax:858-300-8284
Practice Address - Street 1:7917 OSTROW ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3604
Practice Address - Country:US
Practice Address - Phone:858-300-8282
Practice Address - Fax:858-300-8284
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA116184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist