MEDICARE: KHYZAHA JONES MS, LCMHCA, CRC

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	A20183	NC

General Provider Information

NPI Number	:	1932944329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHYZAHA JONES MS, LCMHCA, CRC

Provider Business Mailing Address
First Line	:	14 TRAILS END S
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-9328
Country	:	US
Telephone Number	:	252-402-7159
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 AZIMUTH CT
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-3102
Country	:	US
Telephone Number	:	919-322-4078
Fax Number	:

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

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/27/2024

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