Provider Demographics
NPI:1740822287
Name:JONES, DIAMOND (MSW)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 SE BALBOA DR LOT 46
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-9740
Mailing Address - Country:US
Mailing Address - Phone:850-253-5653
Mailing Address - Fax:
Practice Address - Street 1:2093 W US 90
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-4308
Practice Address - Country:US
Practice Address - Phone:850-253-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL520177837620OtherLICENSE