Provider Demographics
NPI:1245532118
Name:JONES, WILLIAM JOHEAVEN (LCAS; LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHEAVEN
Last Name:JONES
Suffix:
Gender:M
Credentials:LCAS; LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MOYE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2885
Mailing Address - Country:US
Mailing Address - Phone:252-830-2149
Mailing Address - Fax:
Practice Address - Street 1:401 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2885
Practice Address - Country:US
Practice Address - Phone:252-830-2149
Practice Address - Fax:252-329-0315
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1710101YA0400X
NCC0093841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1245532118Medicaid