Provider Demographics
NPI:1780741785
Name:JONES, VICTOR LARUE (LCSW)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:LARUE
Last Name:JONES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8064
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1064
Mailing Address - Country:US
Mailing Address - Phone:252-451-4451
Mailing Address - Fax:252-454-0009
Practice Address - Street 1:1153 JEFFREYS RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1866
Practice Address - Country:US
Practice Address - Phone:252-451-4451
Practice Address - Fax:252-454-0009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0031921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002160Medicaid
NC206756000OtherMAGELLAN
NC2027300OtherCIGNA
NCC5472OtherMEDCOST
NC1278HOtherBCBS
NC6002160Medicaid