Provider Demographics
NPI:1073996807
Name:JONES, RICHARD (LCAS, SAP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:LCAS, SAP
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS, SAP
Mailing Address - Street 1:120 FOWLER RD
Mailing Address - Street 2:
Mailing Address - City:CAMPOBELLO
Mailing Address - State:SC
Mailing Address - Zip Code:29322-9115
Mailing Address - Country:US
Mailing Address - Phone:864-764-8504
Mailing Address - Fax:
Practice Address - Street 1:120 FOWLER RD
Practice Address - Street 2:
Practice Address - City:CAMPOBELLO
Practice Address - State:SC
Practice Address - Zip Code:29322-9115
Practice Address - Country:US
Practice Address - Phone:864-764-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-4752101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)