Provider Demographics
NPI:1225696552
Name:LENTZ, JON WILLIAM PARMLEY (PHD)
Entity Type:Individual
Prefix:
First Name:JON WILLIAM
Middle Name:PARMLEY
Last Name:LENTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4113
Mailing Address - Country:US
Mailing Address - Phone:401-212-6656
Mailing Address - Fax:
Practice Address - Street 1:115 N DUKE ST STE 1B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2187
Practice Address - Country:US
Practice Address - Phone:919-286-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5526103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist