Provider Demographics
NPI:1932848397
Name:JONES, CRYSTAL LACHELLE (MSW, LCSW-A,SSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LACHELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW, LCSW-A,SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 SUNSET AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3411
Mailing Address - Country:US
Mailing Address - Phone:919-268-0100
Mailing Address - Fax:252-450-6403
Practice Address - Street 1:124 N ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2442
Practice Address - Country:US
Practice Address - Phone:919-268-0100
Practice Address - Fax:252-450-6403
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NC11700581041S0200X
NCP0171351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool