Provider Demographics
NPI:1710440649
Name:JONES, KIONNA JENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:KIONNA
Middle Name:JENISE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7858 PARKMONT DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4830
Mailing Address - Country:US
Mailing Address - Phone:901-216-2049
Mailing Address - Fax:
Practice Address - Street 1:1840 PYRAMID PL # 204
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-1703
Practice Address - Country:US
Practice Address - Phone:901-320-0843
Practice Address - Fax:901-284-9431
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ053394Medicaid