Provider Demographics
NPI:1245430719
Name:PAYNE, JONATHON BLOCKER (MS LPC NCC)
Entity Type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:BLOCKER
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MS LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 CARRIAGE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7331
Mailing Address - Country:US
Mailing Address - Phone:919-496-3444
Mailing Address - Fax:919-496-6452
Practice Address - Street 1:107 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2371
Practice Address - Country:US
Practice Address - Phone:919-496-3444
Practice Address - Fax:919-496-6452
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102735Medicaid