Healthcare Provider Details

I. General information

NPI: 1780983981
Provider Name (Legal Business Name): TA KARRA NICOLE JONES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 17TH ST
OAKLAND CA
94612-4124
US

IV. Provider business mailing address

280 17TH ST
OAKLAND CA
94612-4124
US

V. Phone/Fax

Practice location:
  • Phone: 702-468-4456
  • Fax:
Mailing address:
  • Phone: 702-468-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98079
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: