Provider Demographics
NPI:1225801871
Name:FRAZIER, JOHN WESLEY (LCSWA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLEY
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:704-865-4614
Practice Address - Street 1:5040 E BANDYS XRD
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:NC
Practice Address - Zip Code:28609-8075
Practice Address - Country:US
Practice Address - Phone:828-241-1471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0199531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical