Healthcare Provider Details

I. General information

NPI: 1013804319
Provider Name (Legal Business Name): OLIVIA LOUISE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 MALLARD CREEK RD STE 509
CHARLOTTE NC
28262-9708
US

IV. Provider business mailing address

10150 MALLARD CREEK RD STE 509
CHARLOTTE NC
28262-9708
US

V. Phone/Fax

Practice location:
  • Phone: 980-308-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022418
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17874
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: