Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | P015458 | NC |
NPI | 1336749324 |
---|---|
Provider Name | Dr. Wanda V Jones |
First Address | Charlotte, NC 28269-0240 |
Second Address | Charlotte, NC 28269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2020 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336749324 | (05) | NC |
1336749324 | LCSWA (01) | NC |