Provider Demographics
NPI:1437527082
Name:JONES, TANGER LEE
Entity Type:Individual
Prefix:MISS
First Name:TANGER
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TANGER
Other - Middle Name:LEE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:197 BROOK MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8487
Mailing Address - Country:US
Mailing Address - Phone:252-361-1156
Mailing Address - Fax:
Practice Address - Street 1:197 BROOK MEADOW LANE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551
Practice Address - Country:US
Practice Address - Phone:252-361-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-A-21757101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLCAS-A 21757OtherNC SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD