Healthcare Provider Details

I. General information

NPI: 1477282911
Provider Name (Legal Business Name): AMANDA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 13TH ST
WEST PORTSMOUTH OH
45663-5898
US

IV. Provider business mailing address

1420 13TH ST
WEST PORTSMOUTH OH
45663-5898
US

V. Phone/Fax

Practice location:
  • Phone: 220-221-6520
  • Fax:
Mailing address:
  • Phone: 220-221-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2022
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.185104
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: