MEDICARE: MS. STEPHANIE ANDREA JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184743957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE ANDREA JONES

Provider Business Mailing Address
First Line	:	6584 GRESHAM LN
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-7295
Country	:	US
Telephone Number	:	252-945-7667
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 N MARKET ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-4422
Country	:	US
Telephone Number	:	252-975-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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