Provider Demographics
NPI:1790226645
Name:JONES, NICOLE (LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 E COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-3233
Mailing Address - Country:US
Mailing Address - Phone:813-384-4000
Mailing Address - Fax:
Practice Address - Street 1:348 W HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1543
Practice Address - Country:US
Practice Address - Phone:863-608-7778
Practice Address - Fax:863-608-7779
Is Sole Proprietor?:No
Enumeration Date:2017-03-11
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16111101YM0800X
FL101YM0800X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health