Provider Demographics
NPI:1598264814
Name:WINSTON, JONATHAN ONEAL (LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ONEAL
Last Name:WINSTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SILVER HL
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-5082
Mailing Address - Country:US
Mailing Address - Phone:601-624-3246
Mailing Address - Fax:
Practice Address - Street 1:421 SILVER HL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39208-5082
Practice Address - Country:US
Practice Address - Phone:601-624-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC76991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical