Provider Demographics
NPI:1336749324
Name:JONES, WANDA (LCSW, LCAS)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W MAIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4166
Mailing Address - Country:US
Mailing Address - Phone:929-451-4290
Mailing Address - Fax:704-802-5243
Practice Address - Street 1:260 W MAIN AVE STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4166
Practice Address - Country:US
Practice Address - Phone:929-451-4290
Practice Address - Fax:704-802-1631
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 104100000X, 101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X
NCP0154581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336749324OtherLCSWA
NC1336749324Medicaid