Provider Demographics
NPI:1205640158
Name:JONES, ESTELA ELOISA I (PRSS)
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:ELOISA
Last Name:JONES
Suffix:I
Gender:F
Credentials:PRSS
Other - Prefix:MS
Other - First Name:ESTELA
Other - Middle Name:E
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PRSS
Mailing Address - Street 1:1514 KANAWHA BLVD W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2533
Mailing Address - Country:US
Mailing Address - Phone:681-205-8585
Mailing Address - Fax:681-205-8587
Practice Address - Street 1:210 VIRGINIA ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2211
Practice Address - Country:US
Practice Address - Phone:681-205-8585
Practice Address - Fax:681-205-8587
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23971175T00000X
WV23-971175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist