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General NPI Number Information
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NPI Number | 1760660161
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Entity Type | Individual
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Provider Name | CHARLIE LEE JONES LCSW PIP
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Gender | Male
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 2703 6TH STREET
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City | TUSCALOOSA
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State | AL
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Zip | 35401
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Country | US
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Telephone | 205-394-7602
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Fax | 205-758-5202
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Provider Business Mailing Address
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Address Line | 2703 6TH STREET
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City | TUSCALOOSA
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State | AL
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Zip | 35401
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Country | US
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Telephone | 205-394-7602
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Fax | 205-758-5202
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 01689C
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License Number State | AL
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