Provider Demographics
NPI:1144890765
Name:JONES, CANDACE ELISE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:ELISE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 CHAPEL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-6037
Mailing Address - Country:US
Mailing Address - Phone:205-266-4148
Mailing Address - Fax:
Practice Address - Street 1:436 CHAPEL CREEK LN
Practice Address - Street 2:
Practice Address - City:FULTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35068-6037
Practice Address - Country:US
Practice Address - Phone:205-266-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health