Provider Demographics
NPI:1336749324
Name:JONES, WANDA V (LCSW, LCAS)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:V
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 JOHNSON OEHLER RD.
Mailing Address - Street 2:3-410
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0240
Mailing Address - Country:US
Mailing Address - Phone:929-451-4290
Mailing Address - Fax:704-802-5243
Practice Address - Street 1:4422 JOHNSON OEHLER RD.
Practice Address - Street 2:APT# 410
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269
Practice Address - Country:US
Practice Address - Phone:929-451-4290
Practice Address - Fax:704-802-5243
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 101YP2500X, 104100000X
NCP0154581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336749324OtherLCSWA
NC1336749324Medicaid