MEDICARE: THERESA A TOLES-JONES MS, LPC, CPCS

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	101YP2500X	Professional Counselor	3354	GA

General Provider Information

NPI Number	:	1710473467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA A TOLES-JONES MS, LPC, CPCS

Provider Business Mailing Address
First Line	:	6794 SILVER MAPLE DR
Second Line	:
City	:	REX
State	:	GA
Zip	:	30273-2351
Country	:	US
Telephone Number	:	404-808-3736
Fax Number	:

Provider Business Practice Location Address
First Line	:	6794 SILVER MAPLE DR
Second Line	:
City	:	REX
State	:	GA
Zip	:	30273-2351
Country	:	US
Telephone Number	:	404-808-3736
Fax Number	:

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

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	07/05/2018

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