Provider Demographics
NPI:1932944329
Name:JONES, KHYZAHA (MS, LCMHCA, CRC)
Entity type:Individual
Prefix:
First Name:KHYZAHA
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:MS, LCMHCA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TRAILS END S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-9328
Mailing Address - Country:US
Mailing Address - Phone:252-402-7159
Mailing Address - Fax:
Practice Address - Street 1:58 AZIMUTH CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3102
Practice Address - Country:US
Practice Address - Phone:919-322-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health