MEDICARE: LAINE JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1033722871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAINE JONES

Provider Business Mailing Address
First Line	:	128 CANAL PLACE CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-1500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 SAINT ANDREWS RD # SUITTEC1
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4486
Country	:	US
Telephone Number	:	803-638-4688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2020
Last Update Date	:	08/30/2020

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Directions to “ LAINE JONES ” Practice Location

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