Healthcare Provider Details

I. General information

NPI: 1912723925
Provider Name (Legal Business Name): NAQUANA JONES LLBSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9440 LONGACRE ST
DETROIT MI
48228-2013
US

IV. Provider business mailing address

9440 LONGACRE ST
DETROIT MI
48228-2013
US

V. Phone/Fax

Practice location:
  • Phone: 313-319-0869
  • Fax:
Mailing address:
  • Phone: 313-319-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NAQUANA JONES
Title or Position: EMPLOYEE
Credential: MSW
Phone: 313-319-0869