Healthcare Provider Details

I. General information

NPI: 1851171557
Provider Name (Legal Business Name): CHARLES W JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 360
ALBUQUERQUE NM
87102-5317
US

IV. Provider business mailing address

1500 MOUNTAIN RD NW
ALBUQUERQUE NM
87104-1359
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-4656
  • Fax: 505-514-0874
Mailing address:
  • Phone: 505-557-4656
  • Fax: 505-514-0874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0748
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWB-2023-0902
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: