Provider Demographics
NPI:1770716847
Name:JONES, TAHARA NICOLE (LCAS-A,QMHP)
Entity type:Individual
Prefix:
First Name:TAHARA
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCAS-A,QMHP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:NICOLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8648 OLD POTTERS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0927
Mailing Address - Country:US
Mailing Address - Phone:704-661-9654
Mailing Address - Fax:
Practice Address - Street 1:8648 OLD POTTERS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0927
Practice Address - Country:US
Practice Address - Phone:704-661-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3472-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)