Healthcare Provider Details

I. General information

NPI: 1043841562
Provider Name (Legal Business Name): EVELYN JONES LCSW, M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 N MARINE AVE
WILMINGTON CA
90744-3129
US

IV. Provider business mailing address

1238 N MARINE AVE
WILMINGTON CA
90744-3129
US

V. Phone/Fax

Practice location:
  • Phone: 424-305-0333
  • Fax:
Mailing address:
  • Phone: 424-305-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: