Healthcare Provider Details

I. General information

NPI: 1942385547
Provider Name (Legal Business Name): CAROL JEAN JONES Q.M.H.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MITCHELL BLVD STE. #101
SAN RAFAEL CA
94903-2068
US

IV. Provider business mailing address

3255 SAN PABLO AVE APT 417
OAKLAND CA
94608-4363
US

V. Phone/Fax

Practice location:
  • Phone: 415-507-2824
  • Fax: 415-499-3080
Mailing address:
  • Phone: 415-424-7586
  • Fax: 415-499-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: