Healthcare Provider Details

I. General information

NPI: 1336790047
Provider Name (Legal Business Name): SHAYLYN RENEE' JONES LCSW,MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MASSACHUSETTS AVE
SOUTHERN PINES NC
28387-6131
US

IV. Provider business mailing address

4030 WAKE FOREST RD STE 349
RALEIGH NC
27609-0010
US

V. Phone/Fax

Practice location:
  • Phone: 910-585-6364
  • Fax: 253-584-1496
Mailing address:
  • Phone: 910-585-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015908
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC60988973
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: