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General NPI Number Information
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NPI Number | 1649700055
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Entity Type | Individual
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Provider Name | CLARENCE JONES
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Gender | Male
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 08/11/2017
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Provider Practice Location Address
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Address Line | 3600 DEKALB TECHNOLOGY PKWY
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City | ATLANTA
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State | GA
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Zip | 30340-3612
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Country | US
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Telephone | 404-989-3114
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 DEKALB TECHNOLOGY PKWY STE 140
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City | ATLANTA
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State | GA
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Zip | 30340-3617
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Country | US
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Telephone | 404-989-3114
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Fax | 470-282-5102
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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