Provider Demographics
NPI:1114297272
Name:NEWNAM, JOHN LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEE
Last Name:NEWNAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SEDWICK RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9424
Mailing Address - Country:US
Mailing Address - Phone:919-358-0004
Mailing Address - Fax:
Practice Address - Street 1:3125 POPLARWOOD CT STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-6445
Practice Address - Country:US
Practice Address - Phone:919-790-8580
Practice Address - Fax:919-790-8605
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0021001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical