Provider Demographics
NPI:1922256379
Name:JONES, TIARA N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TIARA
Middle Name:N
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 FARGO AVE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-2149
Mailing Address - Country:US
Mailing Address - Phone:510-468-7067
Mailing Address - Fax:
Practice Address - Street 1:660 FARGO AVE
Practice Address - Street 2:UNIT 5
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-2149
Practice Address - Country:US
Practice Address - Phone:510-731-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical