Healthcare Provider Details

I. General information

NPI: 1073865986
Provider Name (Legal Business Name): CASEY ELIZABETH JONES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 SENNA DR STE B
MATTHEWS NC
28105-6727
US

IV. Provider business mailing address

2025 BRANDYWINE DR
MATTHEWS NC
28105-2334
US

V. Phone/Fax

Practice location:
  • Phone: 980-533-5649
  • Fax:
Mailing address:
  • Phone: 704-425-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009105
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1801117577
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerGROUP NPI
# 2
Identifier3410009
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier261QM0855X
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerGROUP TAXONOMY NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: