Provider Demographics
NPI:1851171557
Name:JONES, CHARLES W
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARQUETTE AVE NW STE 360
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-5317
Mailing Address - Country:US
Mailing Address - Phone:505-557-4656
Mailing Address - Fax:505-514-0874
Practice Address - Street 1:500 MARQUETTE AVE NW STE 360
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-5317
Practice Address - Country:US
Practice Address - Phone:505-557-4656
Practice Address - Fax:505-514-0874
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-0902101YM0800X
NMSWB-2024-0065104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health