Provider Demographics
NPI:1073144259
Name:JONES, ACHOVIA D (MS, LCMHCA, LCAS, CS)
Entity Type:Individual
Prefix:
First Name:ACHOVIA
Middle Name:D
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, LCMHCA, LCAS, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-2100
Mailing Address - Country:US
Mailing Address - Phone:336-224-1919
Mailing Address - Fax:336-224-1921
Practice Address - Street 1:8025 N POINT BLVD STE 132
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3262
Practice Address - Country:US
Practice Address - Phone:336-727-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17514101YM0800X
NCLCAS-27958101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639492900Medicaid