Basic Information
| Provider Information | |||||||||
| NPI: | 1881208718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | MARIENA | ||||||||
| MiddleName: | CELENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2911 W GRAND BLVD APT 5129 | ||||||||
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| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103351710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4875 COPLIN ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482152192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138221135 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.