Healthcare Provider Details

I. General information

NPI: 1477472884
Provider Name (Legal Business Name): NELVIN JONES THYME LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 VERONA AVE APT 1A
NEWARK NJ
07104-4774
US

IV. Provider business mailing address

155 VERONA AVE APT 1A
NEWARK NJ
07104-4774
US

V. Phone/Fax

Practice location:
  • Phone: 850-851-3721
  • Fax:
Mailing address:
  • Phone: 850-851-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number37LC00421800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: