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General NPI Number Information
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NPI Number | 1669728259
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Entity Type | Individual
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Provider Name | WILLIE EUGENE JONES JR. MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 2763 HIGHWAY 138 E SUITE A
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City | JONESBORO
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State | GA
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Zip | 30236-2763
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Country | US
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Telephone | 678-545-6745
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Fax |
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Provider Business Mailing Address
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Address Line | 153 BERRYWOOD CT
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City | MCDONOUGH
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State | GA
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Zip | 30253-9244
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Country | US
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Telephone | 404-274-4341
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Fax | 770-954-1474
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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 | LPC006888
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License Number State | GA
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