Provider Demographics
NPI:1558322495
Name:JONES, RUSSELL S (THD, LPC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:S
Last Name:JONES
Suffix:
Gender:M
Credentials:THD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S FRENCH BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3901
Mailing Address - Country:US
Mailing Address - Phone:828-776-5443
Mailing Address - Fax:
Practice Address - Street 1:239 S FRENCH BROAD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3901
Practice Address - Country:US
Practice Address - Phone:828-776-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0045101YP1600X
NC3249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC2488OtherMEDCOST
NC1021GOtherBCBSNC
NC164610OtherVALUE OPTIONS
NC6102486Medicaid