Provider Demographics
NPI:1679213359
Name:KINES-JONES, SUSANNA KAITLYN (LAC)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:KAITLYN
Last Name:KINES-JONES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-4209
Mailing Address - Country:US
Mailing Address - Phone:609-625-3375
Mailing Address - Fax:
Practice Address - Street 1:206 11TH AVE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-4209
Practice Address - Country:US
Practice Address - Phone:609-625-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional