Provider Demographics
NPI:1184862799
Name:WIREN, JASON (CAC I)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:WIREN
Suffix:
Gender:M
Credentials:CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 WINSLOW TER
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6320
Mailing Address - Country:US
Mailing Address - Phone:404-234-9099
Mailing Address - Fax:
Practice Address - Street 1:974 WINSLOW TER
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-6320
Practice Address - Country:US
Practice Address - Phone:404-234-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)