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NPI Code Detail

MEDICARE: MR. JONATHAN ANDREW TRAYLOR LPC, LCAS, NCC

MEDICARE: MR. JONATHAN ANDREW TRAYLOR LPC, LCAS, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-3272NC
2101YM0800XMental Health Counselor9883NC

General Provider Information

NPI Number : 1841536281
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN ANDREW TRAYLOR LPC, LCAS, NCC
Provider Business Mailing Address
First Line : 823 JEFFERSON ST STE 1
Second Line :
City : WHITEVILLE
State : NC
Zip : 28472-3703
Country : US
Telephone Number : 910-508-8904
Fax Number : 910-640-0026
Provider Business Practice Location Address
First Line : 823 JEFFERSON ST STE 1
Second Line :
City : WHITEVILLE
State : NC
Zip : 28472-3703
Country : US
Telephone Number : 910-508-8904
Fax Number : 910-640-0026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2012
Last Update Date : 12/06/2019

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