Healthcare Provider Details

I. General information

NPI: 1699693861
Provider Name (Legal Business Name): ISAIAH ANTHONY JEWETT MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 KILDAIRE FARM RD STE 206
CARY NC
27511-4597
US

IV. Provider business mailing address

1140 KILDAIRE FARM RD STE 206
CARY NC
27511-4597
US

V. Phone/Fax

Practice location:
  • Phone: 919-444-3226
  • Fax:
Mailing address:
  • Phone: 919-444-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberU20971
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: