Provider Demographics
NPI:1598004475
Name:JONES, SANDRA (LPES)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPES
Mailing Address - Street 1:1086 JUDGE RD
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-8229
Mailing Address - Country:US
Mailing Address - Phone:843-774-1854
Mailing Address - Fax:
Practice Address - Street 1:205 KING ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1401
Practice Address - Country:US
Practice Address - Phone:843-752-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4597103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool