Doctor Name: | JASON PERRY |
NPI Number: | 1194170746 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S. |
License Number: | A12298 |
Business Practice Address: | 276 Nc Highway 33 W Chocowinity, NC - 278178023 |
Business Phone Number: | 2524147372 |
Business Fax Number: | |
Mailing Address: | 276 Nc Highway 33 W, CHOCOWINITY |
State: | NC |
Postal Code: | 278178023 |
Phone Number: | 2524147372 |
Fax Number: | |
NPI Enumeration Date: | 05/02/2016 |
NPI Last Update Date: | 05/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | A12298 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |