Provider Demographics
NPI:1598247975
Name:CLEMONS, JONI MARIE
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:MARIE
Last Name:CLEMONS
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 1:9127 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2088
Mailing Address - Country:US
Mailing Address - Phone:810-516-4892
Mailing Address - Fax:
Practice Address - Street 1:1110 ELDON BAKER DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1923
Practice Address - Country:US
Practice Address - Phone:810-742-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016796101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$Medicaid