Individual provider Active NPI

Athena Renee Jones, LCAS-A

  • Addiction (Substance Use Disorder) Counselor
  • Winston Salem, NC
National Provider Identifier
1902480429
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LCAS-28064 Issued in NC
Practice address
1617 S Hawthorne Rd
Winston Salem, NC 27103-4127
Phone
(336) 842-6980
Fax
(336) 842-6984
NPI assigned
May 11, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LCAS-28064 NC Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X CADC-22571 NC

Addresses

Primary practice location

1617 S Hawthorne Rd
Winston Salem, NC 27103-4127

Mailing address

1617 S Hawthorne Rd
Winston Salem, NC 27103-4127
Phone (336) 842-6980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CADC-22571NCMDAddiction (Substance Use Disorder) Counselor
LCAS-28064NCMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1902480429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 S HAWTHORNE RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034127",
            "telephone_number": "336-842-6980",
            "fax_number": "336-842-6984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 S HAWTHORNE RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034127",
            "telephone_number": "336-842-6980",
            "fax_number": "336-842-6984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "ATHENA",
        "middle_name": "RENEE",
        "credential": "LCAS-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-11",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-28064",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "CADC-22571",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.