Provider Demographics
NPI:1568683290
Name:JONES, TERRI RENEE (AS CAC I)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:RENEE
Last Name:JONES
Suffix:
Gender:F
Credentials:AS CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17232 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3434
Mailing Address - Country:US
Mailing Address - Phone:248-559-9340
Mailing Address - Fax:
Practice Address - Street 1:4216 MCDOUGALL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1520
Practice Address - Country:US
Practice Address - Phone:313-923-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)