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General NPI Number Information
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NPI Number | 1265839518
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Entity Type | Organization
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Legal Business Name | ELISA WELLS JONES LCSW LLC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 11557 SORRENTO RD
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City | PENSACOLA
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State | FL
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Zip | 32507-8617
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Country | US
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Telephone | 251-215-9953
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 834
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City | LILLIAN
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State | AL
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Zip | 36549-0834
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Country | US
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Telephone | 251-215-9953
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | ELISA WELLS JONES
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Credential | LCSW
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Telephone | 251-215-9953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW7653
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License Number State | FL
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