MEDICARE: MRS. TAWAINA NICOLE JONES LPC

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	LPC008088	GA

General Provider Information

NPI Number	:	1104210087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAWAINA NICOLE JONES LPC

Provider Business Mailing Address
First Line	:	651 SUPERIOR WAY
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-3277
Country	:	US
Telephone Number	:	678-899-2096
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 BEST RD
Second Line	:	SUITE 400-S
City	:	ATLANTA
State	:	GA
Zip	:	30337-5615
Country	:	US
Telephone Number	:	404-860-1283
Fax Number	:	404-860-1283

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

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	06/04/2015

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