Healthcare Provider Details

I. General information

NPI: 1922762590
Provider Name (Legal Business Name): TIMOTHY M JONES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 RIVERS AVE STE 136
N CHARLESTON SC
29406-4809
US

IV. Provider business mailing address

6650 RIVERS AVE STE 136
N CHARLESTON SC
29406-4809
US

V. Phone/Fax

Practice location:
  • Phone: 765-603-7015
  • Fax:
Mailing address:
  • Phone: 765-603-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: