Provider Demographics
NPI:1215545769
Name:SCIANNO, JASON LEONARD (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LEONARD
Last Name:SCIANNO
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 HENDERSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6365
Mailing Address - Country:US
Mailing Address - Phone:646-734-6924
Mailing Address - Fax:
Practice Address - Street 1:7349 STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3702
Practice Address - Country:US
Practice Address - Phone:646-734-6924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA26632101YA0400X
NCC0152541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)