Provider Demographics
NPI:1619579638
Name:JONES, CAICINA TIANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAICINA
Middle Name:TIANA
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 N EASTLAND ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1707
Mailing Address - Country:US
Mailing Address - Phone:773-524-8234
Mailing Address - Fax:
Practice Address - Street 1:779 N EASTLAND ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1707
Practice Address - Country:US
Practice Address - Phone:773-524-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist