Provider Demographics
NPI:1922673136
Name:JONES, ANDREW SEAN (MA, PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SEAN
Last Name:JONES
Suffix:
Gender:M
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:BARIUM SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28010-0001
Mailing Address - Country:US
Mailing Address - Phone:704-832-2200
Mailing Address - Fax:704-838-1541
Practice Address - Street 1:138 BARIUM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-8453
Practice Address - Country:US
Practice Address - Phone:704-832-2200
Practice Address - Fax:704-838-1541
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103406103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC103406OtherLICENSE