Provider Demographics
NPI:1255527453
Name:JONES, VICKIE B
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:B
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 HUMMINGBIRD PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-8060
Mailing Address - Country:US
Mailing Address - Phone:910-797-0410
Mailing Address - Fax:
Practice Address - Street 1:581 N REILLY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2433
Practice Address - Country:US
Practice Address - Phone:910-797-0410
Practice Address - Fax:910-920-2660
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24-350900106S00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician