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General NPI Number Information
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NPI Number | 1407482169
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Entity Type | Individual
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Provider Name | CARLY NICOLE JONES ED.D
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Gender | Female
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 900 RIDGE RD STE 1S
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City | HOMEWOOD
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State | IL
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Zip | 60430-1934
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Country | US
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Telephone | 312-320-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 9620 S FOREST AVE
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City | CHICAGO
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State | IL
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Zip | 60628-1408
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Country | US
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Telephone | 312-320-7733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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