Healthcare Provider Details

I. General information

NPI: 1891184008
Provider Name (Legal Business Name): TANYA N JONES LCSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WESTOVER DR #13619
SANFORD NC
27330-5001
US

IV. Provider business mailing address

91-1121 KEAUNUI DR STE 108
EWA BEACH HI
96706-6365
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax: 833-419-0181
Mailing address:
  • Phone: 808-551-2228
  • Fax: 808-433-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3087-24NR
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4801
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: