Provider Demographics
NPI:1164442133
Name:STRONG, JEFFREY DEAN (LCSW, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DEAN
Last Name:STRONG
Suffix:
Gender:M
Credentials:LCSW, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 LAKE ROYALE
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-9566
Mailing Address - Country:US
Mailing Address - Phone:919-624-0012
Mailing Address - Fax:
Practice Address - Street 1:3219 KEDENBERG STREET BLDG H-5964
Practice Address - Street 2:SMOKE BOMB HILL ASAP CENTER III
Practice Address - City:FT. BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-908-5952
Practice Address - Fax:910-908-5949
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC674101YA0400X
NCC0011611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003763Medicaid