Provider Demographics
NPI:1255062402
Name:JONES, JELISA M (MA, LAC, NCC)
Entity type:Individual
Prefix:
First Name:JELISA
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1801
Mailing Address - Country:US
Mailing Address - Phone:917-664-2020
Mailing Address - Fax:
Practice Address - Street 1:3 3RD ST
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1370
Practice Address - Country:US
Practice Address - Phone:609-651-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00592500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health