Provider Demographics
NPI:1306222344
Name:JAK COUNSELING SERVICES
Entity Type:Organization
Organization Name:JAK COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-427-8687
Mailing Address - Street 1:107 HOME TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-7848
Mailing Address - Country:US
Mailing Address - Phone:202-427-8687
Mailing Address - Fax:
Practice Address - Street 1:107 HOME TRACE CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-7848
Practice Address - Country:US
Practice Address - Phone:202-427-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health