Provider Demographics
NPI:1780055921
Name:JONES, DENISE MARIE (LSW, LAC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:LSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 LESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-3359
Mailing Address - Country:US
Mailing Address - Phone:317-509-7085
Mailing Address - Fax:
Practice Address - Street 1:9820 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-2303
Practice Address - Country:US
Practice Address - Phone:317-899-2010
Practice Address - Fax:317-898-0060
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000213A101YA0400X
IN33000970A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker