Provider Demographics
NPI:1588734412
Name:JONES, VIRGINIA LEE (CSADC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:CSADC
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LEE
Other - Last Name:TELFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSADC
Mailing Address - Street 1:1753 JEFF RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62893
Mailing Address - Country:US
Mailing Address - Phone:618-249-8781
Mailing Address - Fax:
Practice Address - Street 1:101 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3506
Practice Address - Country:US
Practice Address - Phone:618-533-1391
Practice Address - Fax:618-533-0012
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2193101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL22437OtherCCJAP
IL2193OtherCSADC