Provider Demographics
NPI:1740468941
Name:JINES, ANDA (MS, LPCC)
Entity type:Individual
Prefix:
First Name:ANDA
Middle Name:
Last Name:JINES
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:ANDA
Other - Middle Name:
Other - Last Name:ERCUM-KRASINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:ESPERANZA FAMILY HEALTH CENTER
Mailing Address - Street 2:903 C 5TH ST.
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016
Mailing Address - Country:US
Mailing Address - Phone:505-384-2777
Mailing Address - Fax:505-384-2204
Practice Address - Street 1:16325 HARLEM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2509
Practice Address - Country:US
Practice Address - Phone:708-429-6999
Practice Address - Fax:708-429-6909
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006911101YM0800X
NM0182711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health