Provider Demographics
NPI:1992830475
Name:JONES, MARY BETH (LCADC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:JONES
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 W KINGSTON PARK LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4941
Mailing Address - Country:US
Mailing Address - Phone:410-686-0664
Mailing Address - Fax:
Practice Address - Street 1:39 E CHURCHVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3800
Practice Address - Country:US
Practice Address - Phone:210-638-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA420101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)