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General NPI Number Information
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NPI Number | 1720579428
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Entity Type | Individual
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Provider Name | MS. DESTINEE JONES
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Gender | Female
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 188 W HEBBLE AVE
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City | FAIRBORN
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State | OH
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Zip | 45324-4960
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Country | US
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Telephone | 937-479-7290
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | WALTON
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State | KY
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Zip | 41094-0055
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | OH
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