Provider Demographics
NPI:1285112177
Name:JONES, CONNIE TELISA (LCAS)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:TELISA
Last Name:JONES
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5328 W MARKET ST APT 37E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-4237
Mailing Address - Country:US
Mailing Address - Phone:919-791-7904
Mailing Address - Fax:
Practice Address - Street 1:5328 W MARKET ST APT 37E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-4237
Practice Address - Country:US
Practice Address - Phone:919-791-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23302101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)