Provider Demographics
NPI:1770166258
Name:JONES, LEE ANN (ADS, MSW, LGSW)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:ADS, MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 TROVATO ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-7286
Mailing Address - Country:US
Mailing Address - Phone:304-623-6300
Mailing Address - Fax:
Practice Address - Street 1:27 TROVATO ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-7057
Practice Address - Country:US
Practice Address - Phone:304-623-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19033171100000X
WVBP009458731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist