Provider Demographics
NPI:1750068797
Name:JONES, CIERRA D (CCHW)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:D
Last Name:JONES
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 N CHARLES ST STE B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5768
Mailing Address - Country:US
Mailing Address - Phone:410-826-8266
Mailing Address - Fax:
Practice Address - Street 1:2204 N CHARLES ST STE B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5768
Practice Address - Country:US
Practice Address - Phone:410-826-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01278-23A171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01278-23-AOtherMARYLAND DEPARTMENT OF HEALTH