Provider Demographics
NPI:1245668193
Name:JONES, CASSIDY (MSW)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 UNIVERSITY PKWY
Mailing Address - Street 2:STE. 1560
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6810
Mailing Address - Country:US
Mailing Address - Phone:803-641-6911
Mailing Address - Fax:
Practice Address - Street 1:410 UNIVERSITY PKWY
Practice Address - Street 2:STE. 1560
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6810
Practice Address - Country:US
Practice Address - Phone:803-641-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YA0400X
SC8276225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist