Provider Demographics
NPI:1932116415
Name:MANNING-JONES, GWENDOLYN M (LCSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:M
Last Name:MANNING-JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6331
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-1523
Mailing Address - Country:US
Mailing Address - Phone:919-331-2013
Mailing Address - Fax:919-331-2015
Practice Address - Street 1:45 COMM PARK LN
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5490
Practice Address - Country:US
Practice Address - Phone:919-331-2013
Practice Address - Fax:919-331-2015
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003579Medicaid
NC2869450AMedicare ID - Type Unspecified