Provider Demographics
NPI:1942954284
Name:JONES, DOROTHY NICHOLE
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:NICHOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NW 141ST AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2318
Mailing Address - Country:US
Mailing Address - Phone:954-243-0511
Mailing Address - Fax:
Practice Address - Street 1:701 NW 141ST AVE APT 701NW141
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2313
Practice Address - Country:US
Practice Address - Phone:954-243-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health