Provider Demographics
NPI:1740747179
Name:JONES, AMELIA LAUREL (CDCA-II)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:LAUREL
Last Name:JONES
Suffix:
Gender:F
Credentials:CDCA-II
Other - Prefix:MISS
Other - First Name:AMELIA
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA-II
Mailing Address - Street 1:275 GRAHAM RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2259
Mailing Address - Country:US
Mailing Address - Phone:330-615-7355
Mailing Address - Fax:
Practice Address - Street 1:275 GRAHAM RD STE 2
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2259
Practice Address - Country:US
Practice Address - Phone:330-615-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161053101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty