Provider Demographics
NPI:1235253451
Name:JAREMA, JOHN BLAINE (MA, CRC, LPC, CLCP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BLAINE
Last Name:JAREMA
Suffix:
Gender:M
Credentials:MA, CRC, LPC, CLCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 CHILMARK AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5336
Mailing Address - Country:US
Mailing Address - Phone:919-570-9814
Mailing Address - Fax:919-570-9782
Practice Address - Street 1:1205 CHILMARK AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5336
Practice Address - Country:US
Practice Address - Phone:919-570-9814
Practice Address - Fax:919-570-9782
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3773225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner