Provider Demographics
NPI:1558946525
Name:JONES, WONDA (LSW, PCMHT)
Entity type:Individual
Prefix:MS
First Name:WONDA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LSW, PCMHT
Other - Prefix:MS
Other - First Name:WONDA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW, PCMHT
Mailing Address - Street 1:2610 TRACELAND DR STE B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4226
Mailing Address - Country:US
Mailing Address - Phone:662-231-1969
Mailing Address - Fax:
Practice Address - Street 1:2610 TRACELAND DR STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4226
Practice Address - Country:US
Practice Address - Phone:662-231-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW3150104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker