Healthcare Provider Details

I. General information

NPI: 1699758466
Provider Name (Legal Business Name): JAMES G. JONES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ANDREWS AVENUE
FT. RUCKER AL
36362
US

IV. Provider business mailing address

301 ANDREWS AVENUE
FT. RUCKER AL
36362
US

V. Phone/Fax

Practice location:
  • Phone: 334-255-7387
  • Fax:
Mailing address:
  • Phone: 334-255-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: