Healthcare Provider Details

I. General information

NPI: 1255527453
Provider Name (Legal Business Name): VICKIE B. JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 N REILLY RD
FAYETTEVILLE NC
28303-2433
US

IV. Provider business mailing address

5309 HUMMINGBIRD PL
FAYETTEVILLE NC
28312-8060
US

V. Phone/Fax

Practice location:
  • Phone: 910-797-0410
  • Fax: 910-920-2660
Mailing address:
  • Phone: 910-797-0410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberA4617
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24-350900
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: