Healthcare Provider Details

I. General information

NPI: 1669775813
Provider Name (Legal Business Name): NICHOLAS RAMON DEJESUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 ARCO CORPORATE DR STE 120
RALEIGH NC
27617-2026
US

IV. Provider business mailing address

PO BOX 489
ERWIN NC
28339-0489
US

V. Phone/Fax

Practice location:
  • Phone: 919-346-7600
  • Fax: 910-897-8932
Mailing address:
  • Phone: 910-897-8930
  • Fax: 910-897-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8287
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: