Provider Demographics
NPI:1669728259
Name:JONES, WILLIE EUGENE JR (MA, LPC)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:EUGENE
Last Name:JONES
Suffix:JR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BERRYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9244
Mailing Address - Country:US
Mailing Address - Phone:404-274-4341
Mailing Address - Fax:770-954-1474
Practice Address - Street 1:2763 HIGHWAY 138 E
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2763
Practice Address - Country:US
Practice Address - Phone:678-545-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional