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General NPI Number Information
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NPI Number | 1104790252
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Entity Type | Individual
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Provider Name | JONATHAN CLAY CRAICHY
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Gender | Male
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 915 VANDORA SPRINGS RD
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City | GARNER
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State | NC
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Zip | 27529-3543
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Country | US
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Telephone | 919-283-3302
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Fax | 984-202-2828
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Provider Business Mailing Address
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Address Line | 915 VANDORA SPRINGS RD
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City | GARNER
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State | NC
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Zip | 27529-3543
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Country | US
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Telephone | 919-283-3302
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Fax | 984-202-2828
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P020809
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License Number State | NC
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