Provider Demographics
NPI:1730364449
Name:JONES, MANDY SMITH (MAED, LPC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:SMITH
Last Name:JONES
Suffix:
Gender:F
Credentials:MAED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 CHERRY LANE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-8685
Mailing Address - Country:US
Mailing Address - Phone:252-975-3050
Mailing Address - Fax:
Practice Address - Street 1:730 CHERRY LANE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-8685
Practice Address - Country:US
Practice Address - Phone:252-975-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2183101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool