Provider Demographics
NPI:1891034799
Name:JONES, CHEREATHIA (EDS)
Entity Type:Individual
Prefix:
First Name:CHEREATHIA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 GOODMAN RD # 348
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7333
Mailing Address - Country:US
Mailing Address - Phone:901-296-3399
Mailing Address - Fax:
Practice Address - Street 1:6515 GOODMAN RD # 348
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7333
Practice Address - Country:US
Practice Address - Phone:901-296-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPH4975101YM0800X
MS323163103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty