Provider Demographics
NPI:1760660161
Name:JONES, CHARLIE LEE (LCSW PIP)
Entity Type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:M
Credentials:LCSW PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401
Mailing Address - Country:US
Mailing Address - Phone:205-394-7602
Mailing Address - Fax:205-758-5202
Practice Address - Street 1:2703 6TH STREET
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-394-7602
Practice Address - Fax:205-758-5202
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL01689C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515 25634OtherBLUE CROSS BLUE SHIELD
AL62 00083OtherUNITED HEALTH CARE
AL62 00083OtherUNITED HEALTH CARE