MEDICARE: MS. VICKI CASSANDRA JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1326406711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI CASSANDRA JONES

Provider Business Mailing Address
First Line	:	3628 MADISON AVE
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5069
Country	:	US
Telephone Number	:	916-388-3231
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 MADISON AVE
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5069
Country	:	US
Telephone Number	:	916-388-3231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	07/24/2024

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