Provider Demographics
NPI:1558862128
Name:JONES, WILLIAM-JACQUES LEWIS
Entity Type:Individual
Prefix:
First Name:WILLIAM-JACQUES
Middle Name:LEWIS
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 VASSAR AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-1322
Mailing Address - Country:US
Mailing Address - Phone:330-327-7794
Mailing Address - Fax:
Practice Address - Street 1:830 CHERRY AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1089
Practice Address - Country:US
Practice Address - Phone:330-455-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health