Healthcare Provider Details

I. General information

NPI: 1215852223
Provider Name (Legal Business Name): NISHAWN JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 BANNINGTON RD STE B
CHARLOTTE NC
28226-1341
US

IV. Provider business mailing address

7863 STONEHOUSE DR
GASTONIA NC
28056-9509
US

V. Phone/Fax

Practice location:
  • Phone: 704-859-0355
  • Fax:
Mailing address:
  • Phone: 240-543-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA23180
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: