Provider Demographics
NPI:1508178872
Name:JONES, MARY STERLING (LCAS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:STERLING
Last Name:JONES
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S MANGUM ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3904
Mailing Address - Country:US
Mailing Address - Phone:919-683-1607
Mailing Address - Fax:919-683-1790
Practice Address - Street 1:705 S MANGUM ST
Practice Address - Street 2:SUITE C1
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3904
Practice Address - Country:US
Practice Address - Phone:919-683-1607
Practice Address - Fax:919-683-1790
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112297Medicaid