MEDICARE: MR. WILLIE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1508753716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIE JONES

Provider Business Mailing Address
First Line	:	4771 WASHINGTON AVE
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-9631
Country	:	US
Telephone Number	:	330-296-2384
Fax Number	:

Provider Business Practice Location Address
First Line	:	4771 WASHINGTON AVE
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-9631
Country	:	US
Telephone Number	:	330-296-2384
Fax Number	:	330-296-2466

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

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	06/20/2025

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Directions to “ MR. WILLIE JONES ” Practice Location

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