Provider Demographics
NPI:1780344903
Name:LINARES, JARYTZA AVALOS (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JARYTZA
Middle Name:AVALOS
Last Name:LINARES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 UNION ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5098
Mailing Address - Country:US
Mailing Address - Phone:336-865-5685
Mailing Address - Fax:
Practice Address - Street 1:11 UNION ST S STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5098
Practice Address - Country:US
Practice Address - Phone:704-918-9741
Practice Address - Fax:704-270-6213
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0168281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15193029OtherCAQH