Healthcare Provider Details

I. General information

NPI: 1639475387
Provider Name (Legal Business Name): ZAKIYYAH JONES LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTERVIEW DR STE 309
GREENSBORO NC
27407-3712
US

IV. Provider business mailing address

1 CENTERVIEW DR STE 309
GREENSBORO NC
27407-3712
US

V. Phone/Fax

Practice location:
  • Phone: 336-676-4147
  • Fax:
Mailing address:
  • Phone: 336-676-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4593
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: