Provider Demographics
NPI:1972673978
Name:BOONE, JONNE ALLYSON (LCSW, BCD)
Entity type:Individual
Prefix:MRS
First Name:JONNE
Middle Name:ALLYSON
Last Name:BOONE
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 WAIT AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2727
Mailing Address - Country:US
Mailing Address - Phone:919-570-0312
Mailing Address - Fax:919-570-0382
Practice Address - Street 1:523 WAIT AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2727
Practice Address - Country:US
Practice Address - Phone:919-570-0312
Practice Address - Fax:919-570-0382
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC53123OtherCIGNA
NC60-02093Medicaid
NCB6628OtherMEDCOST
NC131N8OtherBCBS
NC2863823BMedicare ID - Type Unspecified