Provider Demographics
NPI:1770364895
Name:JONES-WIMBUSH, LAQUEYSHA LASHAY
Entity type:Individual
Prefix:
First Name:LAQUEYSHA
Middle Name:LASHAY
Last Name:JONES-WIMBUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10236 MURTY LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3765
Mailing Address - Country:US
Mailing Address - Phone:215-904-2542
Mailing Address - Fax:
Practice Address - Street 1:10236 MURTY LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3765
Practice Address - Country:US
Practice Address - Phone:215-904-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical