Healthcare Provider Details

I. General information

NPI: 1073592267
Provider Name (Legal Business Name): PATRICIA JONES HEARD MSW,LCSW,LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10720 CARMEL COMMONS BLVD SUITE 330
CHARLOTTE NC
28226-3785
US

IV. Provider business mailing address

6728 CONSTITUTION LN
CHARLOTTE NC
28210-4216
US

V. Phone/Fax

Practice location:
  • Phone: 704-542-9883
  • Fax: 704-542-9883
Mailing address:
  • Phone: 704-591-3193
  • Fax: 704-552-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC000810
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number380
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: