Provider Demographics
NPI:1134206022
Name:JONES, ADRIAN E (CSAC, SAP)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:E
Last Name:JONES
Suffix:
Gender:F
Credentials:CSAC, SAP
Other - Prefix:
Other - First Name:ADRIAN
Other - Middle Name:ELAINE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSAC
Mailing Address - Street 1:2008 N DR MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3153
Mailing Address - Country:US
Mailing Address - Phone:414-336-1303
Mailing Address - Fax:
Practice Address - Street 1:6737 W WASHINGTON ST
Practice Address - Street 2:2225
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-5647
Practice Address - Country:US
Practice Address - Phone:414-256-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11659-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39386300Medicaid