Individual
RICKIE JONES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
30 IRA BUNION RD, HAVANA, FL 32333-5349
(850) 321-5617
Mailing address
30 IRA BUNION RD, HAVANA, FL 32333-5349
(850) 321-5617
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017681100
—
FL
Enumeration date
04/21/2019
Last updated
04/21/2019
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