Provider Demographics
NPI:1013685718
Name:JONES, KAMIYA LATESHIA
Entity Type:Individual
Prefix:
First Name:KAMIYA
Middle Name:LATESHIA
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 1:10324 CLOYNE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-0219
Mailing Address - Country:US
Mailing Address - Phone:704-909-8107
Mailing Address - Fax:
Practice Address - Street 1:3210 PROSPERITY CHURCH RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8194
Practice Address - Country:US
Practice Address - Phone:704-548-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0167881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical