Provider Demographics
NPI:1710915186
Name:JONES, SHARON MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
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 1:29029 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2442
Mailing Address - Country:US
Mailing Address - Phone:248-553-9353
Mailing Address - Fax:248-553-9353
Practice Address - Street 1:221 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2653
Practice Address - Country:US
Practice Address - Phone:248-752-1142
Practice Address - Fax:248-629-1432
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008696103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680E017660OtherBCBS PROVIDER ID
OM38830Medicare ID - Type Unspecified