Provider Demographics
NPI:1962776500
Name:JONES, ROGER ALAN (CSAC QP)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:ALAN
Last Name:JONES
Suffix:
Gender:M
Credentials:CSAC QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 JONES FERRY RD APT DD6
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2142
Mailing Address - Country:US
Mailing Address - Phone:919-593-5233
Mailing Address - Fax:
Practice Address - Street 1:605 JONES FERRY RD APT DD6
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2142
Practice Address - Country:US
Practice Address - Phone:919-593-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2681101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2681OtherNCSAPPB