Provider Demographics
NPI:1780997007
Name:JONES, REYNELDA A (LMSW)
Entity type:Individual
Prefix:
First Name:REYNELDA
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 HALL ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3274
Mailing Address - Country:US
Mailing Address - Phone:616-272-2577
Mailing Address - Fax:
Practice Address - Street 1:5150 NORTHLAND DR AVE NE
Practice Address - Street 2:INSIDE THE REMEDY HOUSE
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-319-3863
Practice Address - Fax:616-588-6443
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010912301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4483587Medicaid