Provider Demographics
NPI:1093034324
Name:JONES, MEAGAN ANNE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ANNE
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 W OAK AVE APT I
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2158
Mailing Address - Country:US
Mailing Address - Phone:803-467-5281
Mailing Address - Fax:
Practice Address - Street 1:1788 HERITAGE CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3949
Practice Address - Country:US
Practice Address - Phone:919-556-6501
Practice Address - Fax:919-556-4933
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8818101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC322842Medicaid
SC3347Medicare PIN