Provider Demographics
NPI:1245561117
Name:JEFFREY M WARREN
Entity Type:Organization
Organization Name:JEFFREY M WARREN
Other - Org Name:JEFFREY M WARREN & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LPC
Authorized Official - Phone:919-497-7892
Mailing Address - Street 1:936 CORAL BELL DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4396
Mailing Address - Country:US
Mailing Address - Phone:919-497-7892
Mailing Address - Fax:919-324-3551
Practice Address - Street 1:3749 BENSON DR
Practice Address - Street 2:STE A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7324
Practice Address - Country:US
Practice Address - Phone:919-497-7892
Practice Address - Fax:919-324-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6527251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103542Medicaid