Healthcare Provider Details

I. General information

NPI: 1396346664
Provider Name (Legal Business Name): DOMINIQUE INFINITI JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 PEACHTREE ST NE
ATLANTA GA
30308-1205
US

IV. Provider business mailing address

781 PEACHTREE ST NE
ATLANTA GA
30308-1205
US

V. Phone/Fax

Practice location:
  • Phone: 404-482-3542
  • Fax:
Mailing address:
  • Phone: 470-676-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-20-142134
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC008555
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014787
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: