| Doctor Name: | MR. JONATHON BLOCKER PAYNE |
| NPI Number: | 1245430719 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS LPC NCC |
| License Number: | 4724 |
| Business Practice Address: | 107 Industrial Dr Louisburg, NC - 275492371 |
| Business Phone Number: | 9194963444 |
| Business Fax Number: | 9194966452 |
| Mailing Address: | 2921 Carriage Meadows Dr, WAKE FOREST |
| State: | NC |
| Postal Code: | 275877331 |
| Phone Number: | 9194963444 |
| Fax Number: | 9194966452 |
| NPI Enumeration Date: | 07/23/2007 |
| NPI Last Update Date: | 07/23/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 4724 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |