Provider Demographics
NPI:1326284126
Name:ROSS, JAN (MSW)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BOGARDE ST
Mailing Address - Street 2:F-5
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2105 BOGARDE STREET
Practice Address - Street 2:F-5
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6711
Practice Address - Country:US
Practice Address - Phone:919-382-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health