MEDICARE: MS. ANNETRA JONES MS

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	C-00855	MI

General Provider Information

NPI Number	:	1609107341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNETRA JONES MS

Provider Business Mailing Address
First Line	:	25712 CURRIER ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1703
Country	:	US
Telephone Number	:	313-357-3198
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 2ND AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2739
Country	:	US
Telephone Number	:	313-456-6043
Fax Number	:

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

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	01/20/2010

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