Healthcare Provider Details

I. General information

NPI: 1033638051
Provider Name (Legal Business Name): ROBERT JONES LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 05/28/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 NORTH NC HIGHWAY 41
BEULAVILLE NC
28518
US

IV. Provider business mailing address

116 INDEPENDENCE ST
TEACHEY NC
28464-9436
US

V. Phone/Fax

Practice location:
  • Phone: 910-298-6207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13134
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: