Provider Demographics
NPI:1023275757
Name:JONES, KELLY DELAYNE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DELAYNE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DELAYNE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2310 N PATTERSON ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2568
Mailing Address - Country:US
Mailing Address - Phone:229-244-9688
Mailing Address - Fax:229-244-5354
Practice Address - Street 1:2310 N PATTERSON ST
Practice Address - Street 2:SUITE G
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2568
Practice Address - Country:US
Practice Address - Phone:229-244-9688
Practice Address - Fax:229-244-5354
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0043201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA510380328AMedicaid
GA202I806550Medicare PIN