Provider Demographics
NPI:1255913794
Name:JONES, SAMUEL EUGENE (LCSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EUGENE
Last Name:JONES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HUNTINGTON RD STE 703
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7214
Mailing Address - Country:US
Mailing Address - Phone:678-528-0082
Mailing Address - Fax:
Practice Address - Street 1:1 HUNTINGTON RD STE 703
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-425-8900
Practice Address - Fax:706-425-8600
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPSW28881041C0700X
GACSW0085671041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical