| Doctor Name: | MR. JON WAYNE ECCLESTON |
| NPI Number: | 1306937750 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | C004734 |
| Business Practice Address: | 124 Unionville Indian Trl Rd W Suite A1 Indian Trail, NC - 280795591 |
| Business Phone Number: | 7046080445 |
| Business Fax Number: | 7048219337 |
| Mailing Address: | 124 Unionville Indian Trl Rd W, Suite A1 INDIAN TRAIL |
| State: | NC |
| Postal Code: | 280795591 |
| Phone Number: | 7046080445 |
| Fax Number: | 7048219337 |
| NPI Enumeration Date: | 09/28/2006 |
| NPI Last Update Date: | 09/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C004734 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |