Healthcare Provider Details

I. General information

NPI: 1215129002
Provider Name (Legal Business Name): CONNIE L JONES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 COLLEGE STREET
MACON GA
31201
US

IV. Provider business mailing address

781 COLLEGE STREET
MACON GA
31201
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-2953
  • Fax: 478-742-2953
Mailing address:
  • Phone: 478-742-2953
  • Fax: 478-742-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CONNIE L JONES
Title or Position: OWNER PRESIDENT
Credential: LCSW LMFT
Phone: 478-742-2953