Provider Demographics
NPI:1821109109
Name:JONES, ALISA EVANS (LSW)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:EVANS
Last Name:JONES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 AZALIA RD
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-1907
Mailing Address - Country:US
Mailing Address - Phone:731-645-5753
Mailing Address - Fax:731-645-9885
Practice Address - Street 1:641 EAST POPLAR AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1828
Practice Address - Country:US
Practice Address - Phone:731-645-5753
Practice Address - Fax:731-645-9885
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4118398OtherBCBS PROVIDER NUMBER
TN4118398OtherBCBS PROVIDER NUMBER